New mammogram screening guidelines may put women at risk

Medical Watch

When and how often should a woman have a mammogram? What’s been a long-running debate is under the microscope again after a recent study highlighted the disparity in screening guidelines. Who’s voice should women listen to? A local doctor says it should be your own.

One in eight women will develop breast cancer and more than 40,000 die from the disease each year. Caught at its earliest stage, the cure rate is 99 percent.

Dr Lisa Stempel is a radiologist at Rush University Medical Center.

“Breast cancer is incredibly common just surpassed lung cancer as the most commonly diagnosed cancer in the entire world,” she said.

But when it comes to screening, the numbers are confusing.

“There are many different groups out there that have different recommendations,” Stempel said.

The American College of Radiology and the Society of Breast Imaging recommend screening every year beginning at age 40.

“The reason we follow those recommendations is because the incidence of breast cancer significantly increases at age 40,” Stempel said. “In fact one out of every six breast cancers diagnosed in this country are in women in this age group. So that’s a lot of women who would not be offered the benefits of screening if we don’t start screening them at age 40.”

In 2016, the U.S. Preventive Services task force recommended women should be screened for breast cancer every other year beginning at age 50. The task force acknowledges, “Mammograms can reduce the risk of breast cancer deaths, but women in their 40s are less likely to benefit than older women and more likely to experience potential harms from screening.”

While the task force recommendations are currently under review and may change, according to a spokesperson, the independent panel considered both the benefits and the harms, including the anxiety and stress that comes with false-positive screening results and unnecessary needle biopsies. 

Also weighing in is the American Cancer Society saying annual screening should begin at age 45 for those at average risk, while those 40 to 44 should have the option to start having mammograms.

So, which guidelines should women follow? 

“I want women to be able to make their own decision based on facts supported by science,” Stemple said. “They should talk to their doctor and read as much as they can.”

Is there a financial advantage for breast centers to screen more patients? Stempel says money is not a factor. 

“Seventy-five percent of women who are diagnosed with breast cancer in their 40s have no family history. They are average risk,” she said.  “So we don’t want to only offer screening to women who are of higher risk.”

Recentl, a 48-year-old patient had her annual mammogram, plus a special ultrasound to screen her dense breast tissue.  It helped doctors detect a cancerous lesion.

“We did the biopsy, we clipped it, it was an invasive lobular cancer, which is a classic type of breast cancer that can hide in dense breast tissue,” Stemple said. “She ended up with negative lymph nodes, excellent prognosis and Stage One breast cancer. … If she had waited until 50 before she came and got her mammogram this would be larger without a doubt and it could have spread to her lymph nodes.”

Adding to the argument, Stempel said breast cancer in black women typically presents earlier. 23 percent of cases occur before age 50.

The bottom line: Talk to your doctor and educate yourself so you can make an informed decision about screening.

Copyright 2021 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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