The latest published research on mammogram use and breast cancer trends in the U.S. offered mixed messages for women who must navigate betwen the dangers of missing mammograms as well as for getting over-treated as a result of them.
A new study released by the Radiological Society of North America warned that new federal recommendations regarding breast cancer screening could result in skipped mammograms and missed cancers.
Patients and doctors must reconcile that latest analysis with previous warnings that breast cancer screening may lead to more harm than good.
"Recommendations on screening mammography are extremely important public policy and we wanted to contribute to that dialogue," Dr. Elizabeth Arleo, who studied mammography screening trends along with a team of researchers at New York Presbyterian Hospital Weill Cornell Medical College, said in prepared remarks. "We get questions all day long from patients and referring physicians on the appropriateness of screening mammography. The inconsistent information is very confusing for everyone."
The U.S. Preventive Services Task Force in 2009 altered previous guidelines on mammograms, recommending screening every 2 years rather than annually for women between the age of 50 and 74 on the grounds that patients were being over-treated for tumors that would have been harmless.
The agency further recommended that women under the age of 50 who aren’t at increased risk of developing breast cancer may not need routine screening, and cautioned against teaching women under them to conduct breast self-examinations.
Results from Arleo’s study, which included over 43,000 screenings performed at Weill Cornell between 2007 and 2010, found that nearly 1 in 5 cancers picked up through mammograms were found in women under the age of 50.
"Nearly 20% of cancers detected with screening mammography were found among women in their 40s," according to Arleo. "It seems unacceptable to potentially miss nearly 20% of the breast cancers we are identifying. This, in our view, would represent a substantial degree of under-diagnosis."
Their findings support the American Cancer Society recommendations over those of the USPSTF, Arleo added.
Researchers earlier this year found that mammogram screening rates declined following the USPSTF’s controversial recommendation, which was rebuffed by the American Cancer Society and other groups when it was issued 3 years ago.
Screening rates declined 5.7% among women aged 40-49 following the USPSTF’s recommendation, with nearly 54,000 mammograms skipped in 2010, according to a Mayo Clinic analysis.
The USPSTF altered its recommendations in light of new data, including a randomized, controlled clinical trial and the Cancer Intervention & Surveillance Modeling Network’s modeling studies, finding that the risk of breast cancer false positives were higher for women aged 40-49 while the risk of developing breast cancer was lower than that of women over the age of 50.
USPSTF urged "the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms."
