Most women can wait until age 50 before getting regular mammograms.
That latest volley in the confusing subject of breast cancer prevention came this week from the U.S. Preventive Services Task Force. It’s a group of physicians and health professionals who write guidelines used by the government and doctors.
“The recommendation is that women between 50 and 74 will benefit the most,” said Dr. Albert Siu, task force chair and an internist specializing in hospice and palliative care at Mt. Sinai Hospital. “The decision to start mammography in their 40s should be an individual choice.”
Women 49 and younger with average risk do not develop breast cancer enough to warrant regular mammograms — and those 75 and older have not been studied enough to warrant the screening, doctors say.
Analyzing a number of studies, the task force found that over a period of 10 years early screening resulted in 21 fewer deaths per 1,000 women in their 60s, eight fewer deaths per 1,000 women in their 50s and three fewer for women in their 40s. Those numbers mean that mammograms are not the magic bullet everyone once assumed.
Postponing mammograms flies in the face of what most people believe. For years, women were told to be vigilant and get mammograms, often beginning at 40. Breast cancer is the second leading cause of cancer deaths in women, after lung cancer.
Overly aggressive treatment of surgeries, radiation and chemo have also led to additional cancers, strokes and heart failure.
A group weighed in with the latest advice on when to begin getting mammograms.
Someone could live the same amount of time with cancer that never affected them, and one in five cases of breast cancer are over-diagnoses, Siu estimates.
“We often hear that screening saves lives,” says Dr. Barry Kramer, director of the Division of Cancer Prevention at the National Cancer Institute. “We do not know that is the case for mammography.”
Unnecessary procedures can cause actual harm, some doctors and advocates warn.
“Short-term harm includes time away from work, nausea, hair loss, surgery, recovery, skin burns,” says Karuna Jaggar, executive director of Breast Cancer Action, an education and activist organization.
She says, “People tend to think the trade-off is a few months of unpleasant treatment for a saved life, but this is not what is actually happening. The reality is there are long-term affects, disfigurement, disability, heart disease and secondary cancers. These are life-threatening effects and they are not ncessarily having their lives saved.”
It’s understandable if women are confused, considering the conflicting advice out there.
The last such change happened just three months ago, when the American Cancer Society said women should start getting regular mammograms at 45. They had previously suggested age 40.
A radiologist uses a magnifying glass to check mammograms for breast cancer.
“Both recommendations acknowledge that the benefits of breast cancer screening increase with age,” Siu says. “Both recommendations advocate informed choices for women at the age of 40. Where there appears to be some disagreement is in that 45-50 range. When you look closely, our recommendation acknowledges that risks of breast cancer and benefits of mammography probably increase over the decade of the 40s so that we don’t believe that 45 or 50 are necessarily hard cut points.”
The National Cancer Institute’s Kramer sees the two recommendations as a convergence.
“No one knows where the magic line is, where they cross and certainly not for any individual woman,” Kramer says. “The task force concluded that it is clear that the line is around the age of 50.”
The U.S. has also been an outlier with mammograms, since most countries recommend starting mammograms at age 50, Kramer says.
Both doctors stressed that if a woman, at any age, finds a lump, she should immediately go to the doctor. Changing the guidelines is not intended to tell people to ignore potential danger.
“What is lost sometimes is this recommendation recognizes the benefits of mammography,” Siu says. “We are not saying don’t do mammography. We are hoping it will actually lead to better use of mammography, particularly older women are likely to benefit the most. And our hope is women in their 40s will make decisions best for them.”