Fewer Mammograms, and no consensus yet on when to begin

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The use of mammograms has decreased ever since the U.S. Preventive Services Task Force (USPSTF) made a controversial recommendation in 2009 advising women in their 40s to wait until age 50 to get routine mammography screenings, and then only every two years.

Even though the initial recommendation caused public outcry from cancer groups such as the American Cancer Society and Susan G. Komen for the Cure, one study presented yesterday at the American Roentgen Ray Society annual meeting found that use of mammograms has indeed fallen significantly since those recommendations. Led by Dr. Lara Hardesty, section chief of breast imaging at the University of Colorado Hospital, researchers analyzed survey results from 50 medical professional offices and found that after the USPSTF guidelines were issued, there was a 36 percent decrease in the number of clinicians who recommended yearly mammograms to women between the ages of 40 and 49.

But Dr. Donna Plecha, division chief of mammography at University Hospitals at Case Medical Center in Ohio, is adamant about screening from ages 40 to 49 because of the benefits of detecting — and thus treating — breast cancers in their early stages.
After reviewing 524 biopsies from women in their 40s between 2008 and 2009 at her hospital, Dr. Plecha noted that out of the 359 biopsies from screening mammography patients, 15 percent had cancer (true positives).

However, the USPSTF stands by its guidelines, which takes into account the high number of false positives — and consequent anxiety and unnecessary biopsies — that arise from screening women younger than 50. Dr. Virginia Moyer, chair of the task force, noted that the benefit to women in the 40 to 49-year-old age group is small and made clear that “there are also risks, and they are greater in younger women than older women. The data that we have suggests that one in a thousand will benefit from mammograms in the 40 to 49 range.”

ACSH's Dr. Gilbert Ross recommends following the USPSTF guidelines, most notably because the higher tissue density in breasts of women below 50, along with the much lower frequency of actual breast cancer, makes for a disconcerting number of false positives. As Dr. Moyer observed, “This is a decision that should belong to the woman with appropriate info at hand.”