Cut Through the Mammogram Confusion

Are you a woman? Are you confused about when you should start getting mammograms? Then you are probably not alone.

Last month the American Cancer Society announced a major shift by revising its guidelines. It now recommends that most women who are of “average risk” of getting breast cancer can wait until they are 45 to begin getting annual mammograms. In addition, the ACS said that women who are 55 and older can cut back their mammogram screenings to every other year. (Basically, average risk means you have no sisters, mothers, or other close relatives who have had breast cancer, nor do you have a genetic mutation known as BRCA1 or BRCA2).

The main reasons for the ACS guideline revision? It is trying to move away from two issues: “false positive” results and “over-diagnosis.” In the case of a false positive, this may lead women to undergo unnecessary follow-up tests, including invasive biopsies. There are psychological, physical and economic costs that come with a false positive.

The ACS also cautions against "over-diagnosis," which occurs when mammogram screenings detect slow-growing cancers that may never threaten a woman's life. Because doctors can't tell which breast tumors are essentially harmless, they end up treating all of them.

However, several other important health organizations, including The American College of Radiology and Society for Breast Imaging, and The American College of Obstetricians and Gynecologists (ACOG), think the benefits of getting mammograms starting at age 40 outweigh the possible harm of false positives and over-diagnosis. Both of those organizations are sticking with their current recommendations.

Says the ACOG, “We recognize that guidelines and recommendations evolve as new evidence emerges, but currently ACOG continues to support routine mammograms beginning at 40 years as well as continued use of clinical breast exams. ACOG recommendations differ from the American Cancer Society’s because of different interpretation of data and the weight assigned to the harms versus the benefits.”

For the record, here are ACOG’s current recommendations:

• Screening mammography every year for women aged 40 to 49 years
• Screening mammography every year for women aged 50 years or older
• Breast self-awareness has the potential to detect palpable breast cancer and can be recommended
• Clinical breast exam every year for women aged 19 or older

Dr. Denise Rable, who is a breast surgical oncologist at INTEGRIS (and the guest doctor on our most recent Ask A Doctor series) weighs in. “I worry that the news is confusing to women, and I think having so many conflicting recommendations devalue mammograms. But mammograms are very important," she says.

She continues, “The bottom line? Mammograms do save lives, they do detect cancers at an early stage, when tumors are easier to treat. Eliminating them up front will eliminate false positives, but then you’ll be losing the images that are cancerous, too.” She says she plans to stick with the current standard, and will continue to recommend patients begin routine mammography at age 40.