There has been lots of debate in recent years over when, and how often, healthy women should begin getting mammograms to detect breast cancer.
Tuesday’s announcement of new guidelines from the American Cancer Society isn’t likely to make things much clearer.
“It’s another in the list of competing recommendations for breast cancer screening,” said Dr. Stephen Blaha of Eastover OB/GYN Associates in Charlotte. “It makes it very confusing for both patients and physicians.”
The controversy began in 2009, when the U.S. Preventive Services Task Force, a panel of experts that advises the government on the value of screening tests, raised the recommended age to begin mammography from 40 to 50, and specified every other year instead of annually. The task force concluded that the benefit of testing younger women was small.
Even after that recommendation came out, the American Cancer Society and other respected physician groups continued to recommend screening should start at 40.
This week, the cancer society relaxed its guideline too. Its new recommendation is to start mammograms at 45, continuing once a year until 54, and then every other year. That’s a big change, but the ACS also allowed that women under 45 and over 54 should still “have the opportunity” to have the test if they choose.
It makes it very confusing for both patients and physicians.
Like many doctors I’ve spoken to about mammography, Blaha said he’ll continue to recommend that his patients start getting tested at 40. “I don’t think I will change just based on this, but I’m open to reconsidering that.”
“Patients should be reassured that (medical professionals) are willing to look at data and make changes as more information becomes available,” Blaha said. But for now, he added, “I would rather do extra screening and identify cancer early. We know if you identify it early, you’re going to have a better outcome.”
In making recommendations about mammography, experts try to balance the benefits of a test – early detection and cure – against its potential harms – anxiety over false-positive results, repeat scans with radiation exposure and unnecessary biopsies and treatments.
But Dr. Matthew Gromet, chief of mammography at Charlotte Radiology, says the potential harm from mammography has been “way over-stated.” Patients are recalled about 10 percent of the time, he said. And two-thirds of those cases are resolved with nothing more invasive than another mammogram or ultrasound. “Is that harm? Or is that just part of the screening process?”
Gromet calls the Preventive Services Task Force “misguided” and believes the cancer society’s new guideline is “another point of confusion for women.” Even the new guidelines are based on reviews of old research that doesn’t reflect new technology, such as digital mammography, which produces fewer false positives.
Like Blaha, Gromet continues to support starting mammograms at 40. “It saves lives,” he said. “That’s proven.”