Just a few years ago the U.S Preventive Services Task Force weighed in PSA screening for prostate cancer. The USPSTF took several years to get it right. Now the USPSTF is providing advice on guidelines for mammography. The USPSTF is an independent panel of experts in primary care and prevention. The release of new guidelines on mammography never fails to renew the heated controversy over the potential benefits and harms.
Screening mammography is done in healthy women to spot small undetectable breast cancers that cannot be palpated on breast self-examination. Some expert groups say that women should begin having regular mammograms at age 40, others set the start age at 50. The age at which women should stop having mammograms is also disputed.
The American Cancer Society and other medical organizations recommend that women begin getting regular mammograms at age 40. The USPSTF, in contrast, advises women between the ages of 40 and 49 to talk with their doctors to make their own decisions about screening depending on how they value the potential benefits and harms of mammography.
Many women and their doctors don’t think much about the possible downsides of screening mammography. A statistical model included in the USPSTF draft shows that annual mammograms among 1,000 women in their 40s would prevent one death compared to 1,000 women of the same ages who didn’t have mammograms (7 vs. 8). But screening in this age group would also trigger 576 false positive tests, 58 unnecessary breast biopsies, and two extra over-diagnosed tumors (20 vs. 18) that would not have affected health or longevity.
While annual mammograms save lives, there are many false positive scans and a small number of over-diagnosed tumors. Individual women may weigh these numbers differently and make different value judgments in deciding whether to start having mammograms at age 40.
For women ages 75 and older, the USPSTF panel continues to say that there isn’t enough evidence to recommend for or against routine mammograms. Other experts suggest that mammograms make sense for women in this age group who are expected to live 10 or more years, based on their good health.
Bottom Line: Just like PSA screening test for men to diagnose prostate cancer has offered the recommendation that men should have a discussion with their doctor; the same applies to women and obtaining a mammogram screening. The doctor and the patient can reach a decision regarding whether to proceed with a mammogram.