If you’re a 40-year-old woman, should you get a screening mammogram? What if you’re over 55—should you still get a mammogram every year? This is the Mammography Controversy. Some sources say, maybe. It depends, according to others.
Dev Paul, DO, PhD, a Rocky Mountain Cancer Centers breast cancer specialist, has one definitive answer to both questions: yes.
I recommend having a mammogram every year for women age 40 and over; maybe sooner depending on family history.”
While there are a lot of confusing and often changing recommendations and guidelines being published and debated, Paul says the bottom line is clear: When breast cancer is diagnosed early, the chances of a cure are excellent.
In the past few years, both the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) have changed their guidelines for breast cancer screening, with both delaying the longstanding recommendation to begin annual screening mammograms at age 40 for women at average risk.
The USPSTF now advises women under 50 to discuss mammography risks and benefits with their physician, then make an “individual decision” about when to start breast cancer screening. In 2015, the ACS also altered its guidelines, recommending that most women start annual mammograms at 45 rather than 40, and also suggested that at 40, women should discuss their options with a doctor. The ACS, like the task force, now recommends that women over 55 get a mammogram every other year.
Both organizations reasoned that exposure to radiation, which occurs with mammograms, poses some risk. In addition, the groups cited the possibility for “false positive” results, which can result in unnecessary biopsies and anxiety to a woman. The risk of radiation exposure and unnecessary biopsy is statistically greater, the task force decided, than the number of deaths averted by screening tests for women 40 to 49. In addition, it cited the difficulty of gaining accurate images of dense breasts, which typically occur in younger women.
Those recommendations were issued by a well-qualified panel that reviewed masses of data. Nevertheless, the recommendations drew protest from advocacy groups, some medical organizations, and physicians, including Paul and many of his Rocky Mountain Cancer Centers colleagues.
Paul points out that data was old. “When those studies were done, the quality of mammography was not as good as it is now,” he says.
“The technology is getting better and better, and we are able to accurately diagnose smaller and smaller tumors.” Technologies like 3D mammography (tomosynthesis), and more precise digital mammography are reducing the risk of false positives, reducing radiation exposure, and providing better images of dense breast tissue, Paul says.
In any case, Paul says, a false positive creates a week or two of anxiety, which is admittedly trying. But in his estimation, more difficult is a diagnosis of a later-stage cancer that could have been more easily and successfully treated with earlier detection.
“The bottom line is, detecting cancer early saves lives,” Paul says.