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Don’t discourage early mammograms

The American Cancer Society recommends women get breast cancer screenings at 45.
The American Cancer Society recommends women get breast cancer screenings at 45. AP

From Michelle L. Rivera, a radiologist in Charlotte:

As a local board-certified radiologist and fellowship trained breast imager, I understand the significance of catching cancer as early as possible. Up until recently, I took solace in knowing that the women I treat and see everyday have access to life saving breast cancer screening services beginning at age 40. But suddenly everything changed.

The United States Preventive Services Task Force (USPSTF) introduced draft guidelines which raise the screening age from 40 to 50, meaning 22 million women ages 40 to 49 could lose insurance coverage (co-payment, co-insurance, or deductible) for mammograms. To make matters more complex, the American Cancer Society recently released its updated guidelines, raising the screening age from 40 to 45, leaving women and doctors thoroughly confused.

That’s why I traveled to Washington, D.C., on Dec. 3 to tell Congress to pass the Protecting Access to Lifesaving Screenings (PALS) Act. This legislation, co-introduced by U.S. Rep. Renee Ellmers, R-N.C., would place a two-year moratorium on the guidelines, allowing time for concerns from the medical community and patients to be addressed and for new and emerging technologies to be included. Meanwhile, women would have continued access to mammographic breast cancer screening.

As a doctor on the front lines, I can tell you that early detection is our best defense against this deadly disease that will claim the lives of an estimated 40,000-plus women just this year. If the draft USPSTF recommendations are implemented, cancers may not be caught at all or found at a later stage when mortality rates are higher and more invasive and costly treatments are needed.

Further, we know that women who develop breast cancer in their forties often develop more aggressive types of cancer with a worse prognosis. So why limit access to mammograms for women in this age group?

Supporters of the recommendations suggest the “harm” and fear of false positives is a reason not to screen women under 50. They say that a false positive can cause emotional, practical and economic toll on women because follow up visits lead to anxiety, co-pays and other out-of-pocket expenses when nothing may be wrong. We all understand that recalls from screening for additional imaging may cause short-term anxiety, but that can hardly be compared to the real harm of dying of breast cancer.

Further, there is no such thing as a cancer that goes away without treatment. Until science can tell us with certainty which cancers are killers and which, if any, are not, we need to screen early and regularly with the aim of finding breast cancers as early as possible.

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