Two new studies show that the United States Preventive Services Task Force recommendations have had a significant impact on mammogram screening in women younger than 50, with screenings plummeting in that age group. NBC News Chief Medical Editor Dr. Nancy Snyderman provides some insights into the controversial issue.
Q. Do you consider it good news that fewer women aged 40 to 49 are being screened?
A. The USPSTF recommends mammograms every two years for women ages 50 to 74 years. These recommendations are the culmination of years of research by scientists objectively looking at the numbers to better understand how we could use mammograms to save lives. According to these researchers, there has been a decline in the number of women 40 to 49 getting mammograms. That means patients are listening and making decisions based on their individual health characteristics and risk factors. This is what you want people to do when the science gives them choices.
Although the American Cancer Society and the National Cancer Institute recommend that annual screening beginning at age 40, the decision lies in the hands of patients and their physicians. Women younger than 50 should talk to their doctors about their family history as well as the risks and benefits of mammograms before getting screened.
Q. The new research shows that experts continue to disagree about this issue. If that’s the case, how can women sort through the confusion?
A. Ultimately, women and their doctors need to sit down and have this conversation. Early screening can be a great thing, but it comes with its fair share of risks, including radiation exposure and the risk of a false-positive result. The important thing is that for women that decide they want to be screened earlier, they still have the right to chose, and those women over 50 that need mammograms are still getting them.
Q. In one new study, more than half of doctors said they discussed individual risks and benefits with patients instead of relying simply on the screening guidelines. Ultimately, is that the answer? Ask the doctor about your particular risk?
A. This underscores the importance of individualizing medicine. The science is clear on the overwhelming benefits of mammography for women 50 years or older, but for women ages 40 to 49, it is important that patients and their doctors examine all the information before recommending any tests. If I were 29 years old and had 3 family members with breast cancer before age 40, I might consider it a mistake to wait until age 50 to be screened. But for women with no family history, the conclusion may be different. The bottom line is you still have a choice.
Q. If a 40-year-old woman had no risk factors, but was simply worried, should she go ahead and request screening? Is peace of mind enough of a reason?
A. As someone with no family history, if I just turned 40, I might consider waiting until age 50 to get screened. But for women who are anxious, have lumpy breast or large breasts you might want to start screening earlier after considering your options. Just understand that it might not be necessary. Radiation exposure has a cumulative effect and the risk of false- positive results and unnecessary biopsies is not a negligible one.
Q. You’ve said that after years of recommending early screening, you changed your views based on the new guidelines. Do you still feel that way?
A. I have always been a supporter of screening and preventive medicine. However, when it comes to the 40- to 49-year-old group, there is no proof that screening saves lives. It may save your breasts, in the sense that earlier detection may give a woman more surgical options in terms of lumpectomy verses radical mastectomy, but it may not add years to your life.
Q. What is the take-home message about breast cancer screening?
A. The take-home message is that women should listen to the controversy and make an informed rational decision about what is best for their health. As uncomfortable as this debate makes people, this sort of inquiry is exactly what makes science great. It’s your body and the more you know about the pros and cons, the more informed your health choices will be. Ultimately, the choice is yours. No one is denying women the right to get a mammogram, but you should know that if you don’t have any risk factors, the science is on your side if you choose to wait until you are 50 to begin annual screening.
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