Mammogram Study Reignites Controversy on Breast Cancer Screening


"At this time, screening mammography is the best tool we have," said Dr. Donna Plecha, director of breast imaging at University Hospitals Medical Center in Cleveland. "The earlier we catch breast cancer, the easier it is to cure."

"The risk of breast cancer is reduced in women under 50, [but] when it occurs, the impact on patient longevity, productivity and both the family and society is enormous," said Dr. Gary Lyman, director of comparative effectiveness and outcomes research at Duke University in Durham, N.C., emphasizing the need to catch breast cancer early in younger women.

Most Physicians Support Mammograms in Women 40-49

Though current USPSTF recommendations do not urge universal screening for women under the age of 50, physicians seem to have a different take.

"The facts are that the age of 50 has no biological or scientific importance when it comes to mammography screening," said Dr. Daniel Kopans, professor of radiology at Harvard Medical School and senior radiologist in the Breast Imaging Division at the Massachusetts General Hospital in Boston. "There is clear benefit for screening beginning by the age of 40, and age 50 should be dropped as a threshold."

Screening mammography does carry some costs and risks such as false positive results, noted Dr. Carol Lee, chairwoman of the American College of Radiology's Breast Imaging Commission.

However, she said, "In my opinion, the benefits far outweigh the potential harms, and screening should be performed annually starting at age 40 for women at average risk for breast cancer."

Despite the strong opinions of those who favor earlier screening, though, some breast cancer experts still believe that the benefits of mammography have been overstated.

"So many other studies that have been done, where the methodology is clear and very well done, have shown no benefit in this age group," said Fran Visco, president of the National Breast Cancer Coalition, who called mammograms in this age group "outdated and ineffective." "We need to focus on issues that will prevent breast cancer and that will truly save many lives."

"Analyses of screening have shown that there is a high rate of over-diagnosis, with many women undergoing radiation and surgery per woman saved, as well as many false positive mammograms," said Dr. Lee Green, professor of Family Medicine at the University of Michigan. "It's not enough just to know how many women were saved, we have to know how many were hurt to save them."

Mammogram Recommendations Unlikely to Change... Yet

Currently, there is no sign that the USPSTF plans to change its recommendations.

Dr. Ned Calonge, USPSTF panel chair and chief medical officer of the Colorado Department of Public Health and Environment, had not read the study yet, but had concerns about the way the study was done. He said the study will be included in the USPSTF's review of new studies. However, he was skeptical that it would result in any changes in their recommendations.

Meanwhile, since the USPSTF recommendations came out, several medical journals and prominent epidemiologists have supported the notion of backing away from regular screening of 40-year-old women. As it stands, the American Cancer Society recommends annual screening of women 40 and older, while the National Cancer Institute recommends screening for women 40 and older every one to two years.

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