There has been a longstanding debate over the most appropriate age to begin mammography screening and the frequency of screening examinations. As with all screening tests, the decision to perform a mammogram must include an evaluation of the benefits and the risks of the screening tool, as well as a consideration of patient preference.
The recent controversy about mammography should not suggest that there is debate about the most important issues. Most breast cancer experts agree far more than they disagree. For example, there is no debate that mammography reduces the risk of dying from breast cancer. As stated in the new USPSTF recommendations, extensive scientific evidence demonstrates that mammography reduces breast cancer mortality both among women aged 50 and older, as well as among women aged 40 to 49.
Because breast cancer false positive results are more common in women under 50, some argue for a different screening approach in women 40-49 than in those over 50. The USPSTF suggests that women 40-49 consider their individual risk of developing breast cancer before making a decision about screening mammography. They further suggest that those women at increased risk should strongly consider regular mammography screening. Women at lower risk, who wish to initiate screening in their 40s should recognize that the benefits of screening are less than in older women.
As to the timing of mammography, the USPSTF also suggests that screening every other year is likely to be as effective as annual screening, and that this approach would decrease false positives. Biennial screening is already practiced in many countries. Different organizations, based on a review of the same data, may recommend either yearly or every other year screening for women at average risk of breast cancer between the ages of 40-75. We believe that the timing of assessment is best left to a woman and her health care provider. We call upon third party payers to fund annual mammography if a woman and her health care provider opt for this approach. There are no studies that directly address the role of mammography in women over the age of 75. We recommend that older women, particularly those in excellent health, discuss the role of ongoing screening with their health care provider.
One-third of all American women do not undergo regular screening. The failure of age appropriate women to undergo mammography costs lives and reflects problems with access to care and breast cancer education. We need to work as rapidly as possible to correct these deficiencies, and Susan G. Komen for the Cure continues to fund research and education designed to eliminate health care disparities.
We want to eliminate any impediments to regular mammography screening for women age 40 and older. It is our view, however, that the exact timing of assessments is less important than guaranteeing access to screening. New screening approaches and more individualized recommendations for breast cancer screening are urgently needed. Susan G. Komen for the Cure supports research initiatives designed to improve screening, and we believe that it is imperative that this research move forward rapidly.