In November of 2009, the USPSTF (U.S. Preventive Services Task Force) assembled by the Agency of Healthcare Research announced their recommendations stating:
1. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
a. Grade: B recommendation.
2. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.
The American Cancer Society still recommends annual mammography beginning at age 40.
The disagreement continues today, and there is an assembly of international experts that are trying to develop a consensus as this article is being written. I have my doubts as to whether a succinct answer will evolve, for two of the elements at the heart of the discussion are cost effectiveness and ultimate improvement of survival.
Arguments used against annual screening are as follows:
1. There is upwards of 40% over diagnosis rate(mammography diagnose lesions that are ultimately not cancer)
2. The median age for breast cancer is 61-years-old
3. 1/8 women will develop breast cancer sometime during their life , but the survival rates are ever improving
4. 32.5 out of every 100 women have been diagnosed with Ductal Carcinoma in Situ (DCIS) because of the more frequent use of mammography, and there is no clear cut evidence of the progression of this process to invasive cancer
Arguments for annual screening beginning at 40 are:
1. 10% of breast cancers arise in women 35-44 and another 22.6% in women the ages of 45-54
2. 40% of breast cancers occur below the age of 50-years-old
3. 15% of women diagnosed with DCIS on biopsy will have frank cancer when the area is totally excised
4. Mammography identifies cancers earlier, and survival rates are better the earlier the stage of cancer.
A newer finding, which has stirred even more controversy, presented by Dr. Nicholas Perry of the London Breast Institute, demonstrated that of the women under age 50 who received mammograms within a year of diagnosis of breast cancer needed mastectomy 50% less of the time compared to those who didn’t receive regular mammograms. Dr. Perry argues that up to 40,000 women under the age of 40 will be diagnosed with breast cancer in the U.S. next year. With annual mammography screening, we should be able to reduce the need for mastectomy in over 15,000 women.
As Dr. Bernstien clearly stated (see blog), we agree with the American Cancer Society’s recommendation for annual mammography beginning at age 40.
2) Lancet (Nicholas Perry) Vol. 379 Issue 9823
4) National breast cancer coalition