Riding the Mammogram Guideline Roller Coaster

Have you made your personal peace with the 2009 U.S. Preventative Services Task Force recommendations that annual breast screening should begin at age 50, rather than the previously recommended age of 40? Well, not so fast.

Here comes another set of recommendations, this time brought to you by the American College of Obstetricians and Gynecologists (ACOG). The ACOG is recommending that doctors should offer all women in their 40s the chance to get annual mammograms.

The crux of the difference between the two groups recommendations is the age at which annual mammograms should begin - age 40 or age 50? Unlike the ACOG, the USPSTF’s recommendations are based upon a broad comprehensive look at the numbers, numbers which clearly fire up emotions when we inevitably associate them with our loved one’s. Dr. Michael LeFevre, from the USPSTF, breaks it down like this:

It’s about balancing the benefits and the harms of a test. LeFevre explains that of every 1,000 40-year-old women, 30 would be expected to ultimately die of breast cancer if they never had a mammogram. If those 1,000 women are screened every other year between age 50 and 75, (as recommended by USPSTF), that number drops to 23 deaths. Starting screening in the same group at 40 instead would save one additional life, meaning 22 would die of breast cancer, on average.

What if that one additional life is our’s!?

Part of the numbers analysis is all those women getting annual mammograms from age 40-50 who are not saved from breast cancer in the process but who potentially suffer through numerous false-positives and painful biopsies, and who potentially increase their risk of developing breast cancer due to the cumulative radiation exposure that comes with an additional 10 years of annual mammograms. Dr. Nancy Snyderman, NBC’s chief medical editor, further point outs that because most women’s estrogen levels are still fairly high at age 40, their breast tissue is still generally quite dense, making it hard to distinguish irregularities on a mammogram. So are mammograms the best method of monitoring women’s breast health before age 5o?

One woman writes into the Today Show’s mammogram Q&A section with the following:

“Does anyone else ever look down at their breasts like they are ticking time-bombs?”

That was definitely me prior to my prophylactic double mastectomy. Now I wasn’t your “average” woman with an average risk of developing breast cancer, not as a BRCA2 carrier whose grandmother, mother, aunt and sisters had all battled breast cancer. It was upon learning that I was BRCA positive that I finally felt like I had the specifics I needed to make the decision that was best for me. For most women, those at “average” risk of developing breast cancer, there are little or no specifics, just fear. Disagreements between those we look to for guidance just adds to our anxiety.

What do you think about the lack of unity in voice regarding mammogram guidelines? Does it discourage you? Confuse you? Impact your decisions regarding your own breast screening?

Susan Beausang, President, 4Women.com