HEALTH TALK: Breast Cancer: To Screen or Not to Screen

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1234By Hetal Verma
INDIA New England Health Columnist
CAMBRIDGE, MA–Mammograms are screening exams for breast cancer that are well known to most women over the age of 40. Recently, there have been mixed guidelines regarding the age at which to begin getting a mammogram and how frequently it should be performed. This lack of consensus is based the United States Preventive Services Task Force (USPSTF) having differing recommendations from the American Cancer Society (ACS) and the American College of Radiology (ACR).

The USPSTF has recently set new guidelines that state the mammograms should be performed every other year for women ages 50-74 and may be performed between the ages of 40-49 based on a woman’s preference. The ACR and ACS still recommend screening every year beginning at the age of 40 and continuing for as long as a woman is in good health. Most insurances companies will cover annual mammograms.
There are three primary arguments for and against annual mammography.

The first is anxiety. 8-10% of women who have a mammogram are called back for extra pictures. Most of the extra pictures that are performed help clear the area that initially looked concerning and the women are told that everything is fine. A small percentage of these women are recommended for needle biopsy which involves a 30 minute procedure to get a sample of the area for a definite diagnosis. These extra images and biopsies that may be negative can cause a lot of anxiety that some women would like to avoid.

Second, mammograms can detect very early breast cancers that some people believe may not cause any problems during the course of a woman’s life if they go undetected. However, medical literature shows that most cancers do progress and it is very difficult to know the speed at which each cancer will grow. Breast cancer specialists believe that it’s best to detect and remove cancers as early as possible. The rate of death of breast cancer is only about 19% in the US where screening has been performed annually from age 40. It is 25-30% in many European countries which perform screening every other year beginning at age 50 and almost 50% in India where there is no regular screening. This is likely due to cancers being diagnosed at a later stage in places where screening is not performed every year.

A third item of concern to some women is the radiation. However, it is important to know that the amount of radiation a woman receives from a mammogram equals the amount of cosmic radiation people receive from one Trans-Atlantic flight—something all of us have been on without hesitation.

Breast cancer specialists and women who believe in annual mammography feel that there is one clear reason why a woman should have an annual mammogram beginning at age 40—survival. Although it can miss about 5-10% of cancers, mammography is the only proven test that can detect most breast cancers very early . Women should educate themselves regarding the pros and cons of annual mammography so that they can make the right decision for themselves.

(Dr. Verma is the Director of Breast Imaging at Cambridge Health Alliance. She graduated from the University of Massachusetts Medical School and then completed radiology residency training at UMass Memorial Medical Center. She then continued her training with a fellowship in Breast Imaging at the Massachusetts General Hospital. She is passionate about helping women through the early detection of breast cancer. She is particularly interested in the South Asian population and the growing need for early diagnosis in this population. Dr. Verma also enjoys teaching and serves as a Co-Director for the Harvard Medical School Radiology clerkship at Cambridge Health Alliance.)

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