Annual Mammography After Age 40 Remains Important for Women

by Howard Schaff, MD | Breast Care Center Facility Medical Director

Despite new guidelines and conflicting recommendations, the facts remain clear: breast cancer kills and screening saves lives. 

Long-standing recommendations are now threatened, leaving many women wondering how to be proactive about their breast health. The reasoning behind these conflicting screening recommendations is complex. However, the following facts regarding breast cancer are indisputable:

• Breast cancer remains the second leading cause of cancer death in women.
• One in 8 women will develop breast cancer in her lifetime.
• 75-90% of women who develop breast cancer are at “average risk.”
• Screening mammography significantly reduces a woman’s risk of dying from breast cancer.

According to the American Cancer Society, mammograms should start at age 45, and the U.S. Preventive Services Task Force suggests starting at age 50.  However, tens of thousands of women between the ages of 40-49 will develop breast cancer this year. According to these new recommendations, most of them should forgo screening mammograms and clinical breast examinations. How will these women be diagnosed? When their tumor is visibly deforming or when they develop symptoms from metastatic tumors? 

Risks should always be considered. Some patients think that it’s too stressful to get a mammogram and worry about false positives (when women are called back after screening mammograms for additional views such as an ultrasound or other mammogram views- 8-10% of the time). It is important to weigh this against getting breast cancer and finding it at a later stage resulting in more difficult treatment and less likelihood of cure.  Early detection often results in breast-conserving surgery, better cosmetic results, lower treatment costs, and potentially avoiding radiation and chemotherapy. 

We disagree with the recommendation of limited screening and the idea that saving lives is less important than avoiding potential limitations or “harms” of mammography. Mammography is not perfect. So the next step in the fight against breast cancer is to improve screening and focus on more effective and tailored treatments. 

At the Saint Alphonsus Health Systems Breast Care Centers, we think it is important to use all available tools to detect breast cancer in our patients and recommend annual screening starting at age 40. We have implemented screening digital breast tomosynthesis (3D mammography)* which has been shown to increase the detection of invasive breast cancer by 30-40% while simultaneously reducing the rate of false positives. We also continue to provide breast examinations by our highly skilled mammography technologists as part of the screening evaluation to maximize the chance of detecting breast cancer, as some cancers can be felt but not seen on mammograms due to dense breast tissue or location in an area difficult to include on images.   

We need to continue to improve breast cancer screening techniques and treatment, and physicians and scientists are working hard to do so. In the meantime, we should not deny women the opportunity to benefit from proven lifesaving screening mammography. 

* Digital breast tomosynthesis is currently available at our Boise and Nampa locations 

NOTE:  The federal government passed the PAL’S act that mandates that insurance pays for mammograms for those patients in the controversial 40-49-year-old group for at least two more years.