Early Screening Still Wins

The American Cancer Society recently made a revision in their recommendations on when women should begin to receive screening mammograms for breast cancer. The new announcement suggests women of average risk for breast cancer begin to receive annual mammograms at age 45, rather than 40, and that after age 55, they should get a mammogram only every two years. Women with a family history of breast cancer, or who are otherwise at risk, should screen earlier and more often.

The ACS has been careful to leave their recommendations somewhat open, indicating that women who want to begin screening earlier or receive it annually should be allowed to do so. Still, these changes can be confusing. The question comes down to one important point:  What screening schedule has the best outcome for the most patients?

It’s clear from a number of studies that imaging annually beginning at age 40 saves the most women’s lives. The American Cancer Society, the U. S. Preventative Services Task Force, and the American College of Radiology all agree on this point. These bodies also agree that beginning screening later and conducting it less often will reduce false-positive test results-- and that’s a good goal, but not as important as saving lives.

A 2010 study published in the American Journal of Radiology concluded that 100,000 lives would be saved every decade if annual screening began at 40 and continued through age 84. A study I co-authored this year in the same publication concluded that three-quarters of cancers discovered by mammography in women aged 40-49 were in women of no known risk, emphasizing how critical it is to begin screening early. Yes, the number of false-positive test results will be higher if we continue annual screening from age 40 onward. But a false-positive is not what most people would consider a major harm. In 10 percent of cases, a false-positive results in a second round of imaging; in 1-2 percent of cases, a needle biopsy is performed. These steps and the waiting that accompanies them can certainly be anxiety-producing for patients, but most American women would happily undergo that temporary worry to learn they definitively don’t have cancer.

The bottom line is, choosing to screen later or less often will result in fewer false positives but at a cost of lives lost to breast cancer. Early detection is the key to saving lives. 

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