Mammograms Starting at Age 40
As radiologists, we’re often asked if we’d recommend the same exams to our friends, family or even ourselves if we were in the patient’s shoes. When it comes to recommending annual screening mammograms for women aged 40 and over, the answer from radiologists is a resounding “Yes.”
A study published in the June online edition of the American Journal of Roentgenology surveyed 487 breast radiologists about their mammography screening recommendations. The radiologists were asked about which exams they recommended to their average-risk patients, friends and family; they were further asked if those recommendations were consistent with how they would care for themselves if they were the patient.
The breast radiologists surveyed for the study overwhelmingly practice what they preach, with 98 percent recommending yearly mammography for average-risk women 40 years old and older. The results come despite controversial and well-publicized breast screening recommendations to the contrary from the U.S. Preventive Services Task Force (USPSTF).
The recently updated draft recommendation from the task force essentially re-states its 2009 guidance. The USPSTF recommends screening mammography in average risk patients not to begin until age 50, and then only every two years until age 74, claiming that the net benefit from screening in women ages 40 to 49 was small. USPSTF’s action has resulted in frustration in the medical community, confusion among patients and a 10 percent decrease in screening among women age 40 – 49.
The American Cancer Society (ACS), American College of Radiology (ACR), The Mayo Clinic, the American Medical Association, the American College of Obstetricians and Gynecologists and the National Cancer Institute all support annual screening mammograms for average-risk women starting at age 40.
Predictably, the USPSTF draft recommendation resulted in headlines such as this from Time Magazine, “Most Women Should Not Get Yearly Mammograms, Group Says,” which was picked up and spread nationally across news outlets and social media. In an April 2015 press release on the topic, the American College of Radiology labeled the USPSTF guidelines “untrustworthy” and said the group’s recommendation “would result in thousands of additional and unnecessary breast cancer deaths each year” and could strip millions of women of private insurance coverage for mammograms.
A 2011 study also published in the Journal of American Roentgenology calculated that using ACS mammography screening recommendations instead of USPSTF guidelines would save approximately 6,500 more women’s lives per year. Furthermore, as the ACR points out in its release, the U.S. breast cancer death rate has dropped 35 percent since screening mammography became widespread in the 1980’s.
Despite the confusion and controversy surrounding the USPSTF recommendations, annual breast screening with mammography starting at age 40 is strongly supported by clinical data, and it should remain the standard of care in the early detection and prevention of breast cancer.