Mammogram screening: What you need to know

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By David liu and editing by Rachel Stockton

U.S. Preventive Services Task Force Agency for Healthcare Research and Quality announced today that it now recommends that women begin biennial screening for breast cancer at age 50.  This admonition is for those who have no special risk factors, such as familial predisposition toward the disease.   

In the past, the federal government recommended that women begin regular screening at the age of 40.

Specifically, the USPSTF says it recommends biennial screening mammography for women aged 50 to 74, but not for women aged 40 to 49 years. 

The agency recommends against teaching breast -self-examination procedures; evidence, they say, is insufficient to evaluate the benefits and harms of clinical breast examination.  

Synchronized with the announcement, Georgetown University Medical Center reported a new review published in the Nov 17, 2009 journal Annals of Internal Medicine that suggests "biennial (every two years) screening of average risk women between the ages of 50 and 74 achieves most of the benefits of annual screening, but with less harm." 

The review, funded by the National Cancer Institute, examined 20 screening strategies with different starting and stopping ages and intervals. 

The data derived from the analysis show that screening every other year delivers an average of 81 percent of annual screening results, with almost half the number of false-positives.  

Mammogram screening every other year from ages 50 to 69 reduces breast cancer mortality by 16.5 percent over a life time, compared to no screening whatsoever. Screening beginning at the age of 40 reduces the mortality rate by 19.5 percent, or one woman in every 1000, compared to screening starting at age 50. But false-positives, unnecessary biopsies and anxiety increase.

The new recommendations are influential and healthcare insurers may adopt them to change their policy to reduce use of mammogram screening, which worries many radiologists.  Some diagnostic professionals find the timing of the announcement suspicious, as it coincides with the push for healthcare reform. The doctors claim that the new recommendation was designed specifically to cut costs, not to save lives.

The new recommendations are aimed at reducing the harm associated with mammogram screening, such as false-positives, unnecessary treatment and over-diagnosis.

Mammogram screening is not performed to prevent breast cancer from occurring, but to reduce the mortality rate of breast cancer.  However, some studies provide evidence indicating that this screening does not cut risk of breast cancer death.

Laura Esserman, MD, MBA, professor of surgery and radiology, director of the UCSF Carol Franc Buck Breast Care Center, along with her colleagues, published an article in the Journal of the American Medical Association expressing their concern over the current recommendations and their efficacy with regards to early detection.

Dr. Esserman and colleagues said the method results in increased detection of early stage or non-life-threatening tumors, but the method per se does not reduce the risk of death in patients with aggressive breast cancer. 

Dr. Samuel S. Epstein, professor emeritus of Environmental and Occupational Medicine at the University of Illinois School of Public Health and Chairman of the Cancer Prevention Coalition states on the website preventcancer.com that mammography screening poses a wide range of risks that women are largely unaware of.

For one thing, radiation used in mammography is a cancer-causing agent, according to the U.S. National Toxicology Program. X-rays are the most studied carcinogens, and any tiny bit of exposure results in a small but cumulative risk of initiating and promoting breast cancer.  

Dr. Samuel says postmenopausal women who undergo annual screening for a ten-year period would receive exposure to about 10 rads for each breast. Each rad results in one cancer patient in every 100 premenstrual women. Exposure to 10 rads means the risk of getting breast cancer due to radiation is 10 percent. Even worse, breast cancer risk from mammography is fourfold higher for women who carry the A-T gene. Breast cancer of this sort accounts for 20 percent of all breast cancers annually in the United States. 

Other risks associated with screening mammography include breast compression, which raises risk of spreading the cancer, particularly in postmenopausal women.

Dr. Samuel says "Mammography screening is a profit-driven technology posing risks compounded by unreliability. In striking contrast, annual clinical breast examination (CBE) by a trained health professional, together with monthly breast self-examination (BSE), is safe, at least as effective, and low in cost. International programs for training nurses how to perform CBE and teach BSE are critical and overdue."

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