The Pink Journey Foundation
The debate between starting mammographic screening at age 40 vs. 50 is ongoing, but change is on the horizon. A recent study from the prestigious journal “Lancet” demonstrated a marked reduction in mortality in women who started screening at age 40 as compared to those who started at 50. (Ref 1). Additionally, the Mayo clinic provides a clear explanation as to why they advise women to screening at age 40 (Ref 2). A third report provides strong evidence for repeating mammograms yearly as opposed to every other year (Ref 3).
Another recent study demonstrates that breast cancer death rates are increasing in women under 40, the age at which we encourage women to begin routine screening (Ref 4). This finding can be attributed in part to unidentified risk factors such as a family history of breast cancer. Also, doctors tend to trivialize symptoms in young women because of the assumption that breast cancer is rare in their age group.
The good news is that new technology such as digital mammography, screening ultrasound and MRI allow us to detect small breast cancers that were not visible on older technology. Even more exciting is the application of artificial intelligence to the process of screening. AI is a breakthrough technology (Ref 5). It not only identifies breast cancers that cannot be seen on standard imaging, but it also speeds up the screening process.
- Can Earlier Mammographic Screenings Affect Mortality Rates?
- Mammogram guidelines: What are they (from the Mayo Clinic) https://www.mayoclinic.org/tests-procedures/mammogram/expert-answers/mammogram-guidelines/faq-20057759
- Why Skipping Even One Mammogram Can Be Dangerous for Your Health
- Breast cancer death rates increasing among women under 40
- AI Is Learning to Read Mammograms – The New York Times
The goal of the campaign is to educate women about the benefits of screening mammography beginning at age 40. Women are encouraged to take charge of their own health.
The United States Preventive Services Task Force (USPSTF) has recommended that women wait until age 50 to start mammograms and repeat mammograms every two years instead of every year. The USPSTF is a government-appointed task force made up of primary-care physicians and non-physicians. Their mission is to publish evidence-based guideline for medical care. However, none of the doctors on the task force specialize in breast cancer. We believe this has impaired the committee’s judgment. They’ve made recommendations without the input of expert physicians.
Mammograms are costly and we believe the USPSTF has asked women to wait in order to contain medical costs. Although we are also concerned with the spiraling cost of medical care, asking women to delay cancer screenings is not the solution. Cost reduction is often at the expense of women’s health.
Several major health organizations still recommend women begin mammograms at 40. They include:
- The National Comprehensive Cancer Network (NCCN). An alliance of 27 of the world’s leading cancer centers whose focus is creating better and more effective cancer treatments.
- The Mayo Clinic. The world’s largest non-profit medical group. Their goal is to ensure patients receive the best health care possible through state-of-the-art clinical practices and medical research.
- American College of Radiology. An association of doctors and technicians specializing in radiology and medical imaging. Their members include diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians, and medical physicists.
- Society of Breast Imaging. A group of radiologists, medical physicists, and technicians dedicated to combating breast cancer by improving techniques for early detection. They are strongly opposed to the USPSTF’s mammogram guidelines.
- American Congress of Obstetricians and Gynecologists. A professional membership organization dedicated to the improvement of women’s health.
The connection between mammogram screenings and survival rates has been studied multiple times, and almost every study has demonstrated that early mammogram screenings saves lives. Detecting cancer in its early stages enables doctors to treat it more effectively. More years of life are lost for women in their 40’s than all of the years lost from breast cancer in women 50 and over. Additionally, new breakthroughs such as MRIs, ultrasounds, and 3D mammograms may be able to reduce breast cancer mortality by more than 50-70 percent.
The USPSTF has not provided a clear explanation as to why they’ve made their recommendation to start screening at age 50, but the evidence suggests they may have been swayed by a Canadian cancer study that claimed mammograms were not effective in women 40-49. The study examined a group of breast cancer patients over a span of 25 years and concluded that mammograms did not increase a woman’s chance of survival.
This Canadian study was seriously flawed. It was performed using outdated equipment and its doctors and technicians were poorly trained. Its conclusions are also highly suspect. The second major flaw of the study is a nurse examined all participants before they were assigned to the group that received a mammogram or to the group that did not receive a mammogram. As it turned out, more women with suspicious breast lumps were assigned to the group receiving a mammogram.
There was no benefit from mammography screening when more women who already had advanced breast cancer were diverted to the group was to receive a mammogram. In fact, the study reports that 19 of 24 patients with advanced breast cancer were directed to the group that received a mammogram. This diversion of patients with obvious breast cancer into the group receiving a mammogram in part explains their astonishing conclusion that 22% of breast cancers would “disappear” without treatment. This is a startling conclusion considering there has never been a single documented case of a breast cancer disappearing without standard treatment.
It was this series of flaws in study design that lead the inaccurate conclusion that screening mammography in the 40-50 age group caused more harm than good, when in fact a more recent study from Canada demonstrates a 40% reduction in breast cancer mortality for women who undergo yearly screening starting at age 40.
If they had examined the study with breast cancer experts, they may have discovered the same flaws we did. The reason the researchers thought mammograms didn’t affect the death rate was because all the patients were screened by nurses before the study started. Women with obvious cancer symptoms were funneled into the group that received mammograms, and the women without cancer symptoms were sent into the group that didn’t. This altered the study’s outcome and disguised the role mammograms play in saving lives.
– Dr. John West, Breast Surgeon
Besides the Canadian study, the task force also claimed that breast cancer is over diagnosed and that many of the anomalies uncovered by mammograms are benign and won’t harm patients if left untreated. While this is true for elderly women diagnosed with low-grade, non-invasive cancers, it’s not true for women in their 40’s. For younger women, low-grade, non-invasive cancers will become invasive and life-threatening if left untreated.
The task force was also worried about the risks of false positive biopsies. False positive biopsies occur when doctors detect a spot on a mammogram and order a biopsy, only to discover that the spot isn’t cancerous when the biopsy’s completed. The task force noted that young women are more likely to have false positive biopsies and that false positive biopsies cause a great deal of stress and anxiety in women.
Breast biopsies can cause a great deal of distress, but so does a delayed breast cancer diagnosis. True, younger women are more likely to have a false positive than older women, but they’re also more likely to develop fast-acting and aggressive cancers than older women. The risk of a false positive has to be weighed against the risk of delayed treatment.
– Dr. John West, Breast Surgeon
The decision to start mammogram screenings is a personal one and should be made by women based on their family history and their risk factors, such as a strong family history of breast and ovarian cancer or undergoing chest wall radiation at a young age.
For most women, the general rule is you should start screening ten years earlier than the age your first-degree relative was when they were diagnosed with breast cancer. For example, if your mother or sister was diagnosed when they were 45 you should begin discussions with your physician at age 35.
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