Mammography underused in breast cancer screening

July 2014
By Kathryn M. Lewis MD, Radiation Oncology

A policy recommendation by a U.S. Public Health Service group is putting American women at risk and diminishing the opportunity for early detection of a deadly killer.

Breast cancer guidelines suggested by the U.S. Preventative Services Task Force in 2009 recommend biennial screening mammography for women 50- 74 and discourages teaching breast self-examination techniques to women.

It’s a policy that is both dangerous and wrong.

The USPSTF recommendation is based largely on a determination that film mammography is most effective for women over the age of 50. It also asserts that self-examination can lead to unwarranted panic and expense among women whose adoption of the practice results in false positive results.

But a recent study at the University of Michigan has shown that over the last 30 years, screening mammography has not only identified more early-stage breast cancer, it has decreased the incidence of late-stage disease by more than a third according to a study published in the online journal “Cancer.”

The study examined statistical evidence on the incidence and screening of breast cancer for women − and men − dating back to 1940. Adjusted for temporal trends, late stage cancer incidence decreased by 37 percent over the past 30 years, while early-stage breast cancer detection increased by 48 percent, according to the study.

The results of the study suggest that the positive impact of mammography screening is underestimated − and that the U.S. should adopt a national screening program based on this data.

While it is true that the incidence of breast cancer is higher for women aged 50 and above, the disease can strike at any age. The importance of early detection cannot be overstated, preventing psychologically and physically invasive procedures or even death.

Studies have shown that one woman in 42 will develop breast cancer in her 50s. But the same study indicates that one in 69 will develop the disease in her 40s. Recent data indicates that 17 percent of breast cancer deaths occurred in women diagnosed in their 40s, compared to 22 percent occurring in women who were diagnosed in their 50s. Early detection and treatment provides patients with the likelihood of an improved medical outcome. Early detection and treatment by a woman in her 40s also means she is far less likely to face a reoccurrence of the disease later in life.

The danger of the USPSTF recommendation is that it can influence insurance companies and members of the medical community to dissuade women from self-examination and annual mammograms.

The suggested guidelines do recommend exceptions for those with specific circumstances − such as a family history of cancer − but fail to take into account the overall benefit of early detection by women in their 40s. The study may offer statistical benefits, but these are of little interest to a woman whose cancer goes undetected because her physician or insurance company opts not to take advantage of modern technology and understanding of the disease.

The American Cancer Society takes issue with the suggested guidelines suggested by USPSTF as well. The organization recommends annual screening using mammography and clinical breast examination for all women beginning at age 40.

It is important for women to be informed and proactive about their health. They need to be familiar with their breasts and if they notice something different or unusual, should seek out competent, professional medical advice.

Annual mammography and breast self-examination aren’t just good ideas, they are minimal activities that can save lives.