October is Breast Cancer Awareness Month, so I can’t let it pass without commenting on the American Cancer Society’s (ACS) recently updated screening mammogram guidelines.
Before, the ACS recommended annual mammograms starting at age 40.
Now they recommend annual mammograms for ages 45 to 54, with screening mammograms done every other year after age 55.
But, they add, women should still have the choice to start screening at age 40 and have yearly mammograms thereafter.
The confusion arises not only because the ACS is a bit wishy washy on its guidelines, but because the American College of Obstetricians and Gynecologists (ACOG) still recommends annual mammograms starting at age 40, and the United States Preventive Services Task Force (USPSTF) advises annual mammograms be done every other year, from ages 50 to 74.
To further confuse the issue, more evidence is coming forward that screening mammograms are not saving lives, but rather just diagnosing more cancers. And some of these cancers possibly don’t need to be treated.
What’s a woman to do?
The best advice I can give is to be as self-informed as possible.
Mammograms aren’t perfect
Screening mammograms can miss cancers, giving a false sense of security. For every story I’ve heard of a mammogram saving a woman’s life, I’ve heard several more of a life-threatening cancer being discovered just a few months after a “normal” mammogram.
Mammograms can lead to overtreatment
I think screening tests in general are being overused, and that is resulting in a lot of people being overtreated. We’re becoming more aware that many small cancers of the breast, thyroid and prostate are so slow growing or “indolent” that they (probably) do not need to be treated. If it wasn’t for screening, these non life-threatening cancers would never have been discovered.
Mammograms shouldn’t be “one size fits all”
I am in the camp that less screening is better, or at least more targeted screening.
Anyone with a family history of breast cancer or other risk factors for breast cancer should definitely have a discussion with their health care provider about the frequency of mammograms.
And rather than age, we should consider menopausal status. Picking an average “post-menopause” age of 55 doesn’t fit everyone.
Your physician might not want to talk about it
One of the aspects I find most disheartening about our current health care system is that our doctors are being increasingly micromanaged by their corporate bosses.
Not only do they not have much time to spend on office visits, and they have to keep their eyes glued to their laptops while they talk to us, but they are being evaluated and paid based on meeting certain patient targets or “metrics.” That is, they are strongly encouraged to order all sorts of screening tests—mammograms, PSAs, DEXA scans, lipid profiles, blood glucose, vitamin D, to name a few—whether the tests are really necessary. Or whether the tests have good scientific evidence supporting their use.
It’s in the best interest of the physician to order more screening tests, rather than fewer, which puts us patients at a disadvantage.
Being informed helps
Here are a handful of article or links I’ve found helpful in forming my own plan for mammograms (I take a less-is-more approach):
- Kenneth Lin, MD: The full story on breast cancer screening. But do you want to listen?
- Jen Gunter, MD: Does digital mammography really save lives or is it pink Kool-Aid?
- Science-Based Medicine: The American Cancer Society’s new mammography guidelines: Déjà vu all over again
- The Incidental Economist: New Screening Guidelines Won’t Assure Fewer Mammograms
- Journal of the American Medical Association (JAMA): Breast Cancer Screening: Benefits and Harms (includes a very eye-opening infographic!)
- National Institutes of Health (NIH): Benefits and harms of mammography screening
The insurance factor
Lastly, while some might find the ACS’s new guidelines helpful, insurance companies only pay attention to the screening recommendations made by the USPSTF. Frankly, I find it unusual that most insurance companies still pay for annual mammograms even though the USPSTF only recommends every other year. And I think it possible that insurance companies will stop paying for annual mammograms in the near future, as they continue to try to lower health care costs.
The bottom line regarding screening mammograms is there is no clear right or wrong. It all depends.
Educate yourself, try to talk to your doctor, check your insurance policy, and then make a decision that works for you.
Related post: Better patient education for mammograms