According to a local expert in breast cancer diagnosis, following recent mammogram recommendations from the U.S. Preventive Services Task Force (USPSTF) could result in thousands of unnecessary deaths from breast cancer.
The task force, a medical panel whose recommendations could affect the availability of insurance coverage for mammograms under the Affordable Care Act, released a draft statement April 20 recommending that women begin mammograms at age 50 instead of age 40, and that they have the screenings every two years instead of annually.
“One in six breast cancers occurs in women between age 40 and 49,” said breast imaging specialist Sarah Palestrant, M.D., D.A.B.R., of Larchmont Medical Imaging. “And unfortunately it tends to be the more aggressive breast cancers in that age group.”
“Mammography can detect cancer early when it is more treatable, which not only saves lives, but helps preserve the quality of life,” Dr. Palestrant said. “A recent article in the journal Cancer says that 70 percent of women who died of breast cancer in their 40s in major Harvard teaching hospitals were among the 20 percent of women who were not being screened. The fact is that medical science cannot determine which cancers will advance to kill a woman and which will not. So if we exclude women in their 40s from mammograms, we may lose our chance to catch those cancers early. We could miss the opportunity for early treatment that could save thousands of lives.”
For women age 40–49, the new draft statement classifies mammograms as a Category C recommendation, which, if it becomes official policy, could make coverage for screening mammograms unavailable to women in this age group under the Affordable Care Act.
But the concerns extend beyond the USPSTF recommendations for women in their 40s.
“The recommendation for women age 50 and over is getting less attention, but it’s important not to lose sight of it,” Dr. Palestrant said. “Even according to data cited by the task force itself, having mammograms annually instead of every two years does lower the risk of dying of breast cancer in women 50 and over. So it’s hard to see the logic behind the recommendation of screenings every two years.”
Dr. Palestrant added that virtually every major medical organization that takes positions on issues related to cancer diagnosis and screening continues to support mammograms for women age 40 and over. This includes the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the American College of Radiology.
“The only exception I’m aware of is the U.S. Preventive Services Task Force,” she said. “And that’s a problem, because there isn’t a single breast cancer expert on that panel—no screening experts, no breast surgeons, no oncologists, no radiologists. No one who is an expert in the field is privy to the discussion in those behind-closed-doors sessions.”
So what is Dr. Palestrant’s advice to women about mammograms?
“By all means, talk to your doctor,” she said. “If you’re an adult female, regardless of your age, be sure to provide the information about your personal and family medical history that your doctor needs to evaluate your breast cancer risk. That’s your best assurance of successfully working with your primary care physician to determine the approach to breast cancer screening that’s right for you. And according to the medical consensus, that means, at a minimum, an annual mammogram for a woman age 40 or over. For a woman at higher risk, it could mean starting screenings even younger, additional screenings in conjunction with mammograms, or both.”