• When to start mammograms? Most experts still say 40

    May 2012

    Use of mammography as a standardized screening and diagnostic tool for breast cancer detection has had a significant impact on women’s health in the U.S. Since use became more widespread in the 1990s, breast cancer rates − unchanged for nearly 50 years − dropped more than 30 percent.


    A recommendation that women should not begin [mammography] screenings until age 50 sent shock waves through the medical and women’s health communities. 


    As mammography began to show its benefit to patients, screening guidelines were made by national health care control groups from across the country, and women quickly adopted 40 as the starting age for mammography. However, a 2009 decision by the United States Preventive Services Task Force (USPSTF) sent shock waves through the medical and women’s health communities with the recommendation that women should not begin the screenings until age 50.

    Shifting standards brings criticism

    In the three years since the task force released its support for the change, other health care organizations have continued to strongly disagree. Most recently, in a meeting of its House Delegates in June 2012, the American Medical Association (AMA) voted to uphold screening mammography standards for women starting at age 40. In direct conflict with the Preventive Services Task Force guidelines, the group stated that while not all women should be tested at age 40, they should be “eligible for testing” if they and their health care provider choose to begin at that age.

    The AMA also adopted a resolution and expressed “concern regarding recent recommendations by the USPSTF on screening mammography … and the effects these recommendations have on limiting access to preventive care for Americans.”

    As leaders in the establishment of legislation, policy production and advocacy of safe patient care in the United States, the AMA’s statements carry significant weight within the medical community. Despite the Preventive Services Task Force’s stance on the implementation of routine mammograms, groups such as the American Congress of Obstetricians and Gynecologists, American Cancer Society, American College of Radiology, American Society of Breast Surgeons, American Society of Breast Disease, and Society of Breast Imaging all recommend screenings starting at age 40. The inclusion of the AMA in this group is a sign that many major medical organizations recognize the benefit of early screenings.


    Waiting to start mammograms until age 50 could take the lives of an additional 6,500 women in the U.S. each year. 


    Earlier screenings save lives

    Obtaining mammograms early is shown to be equally beneficial to younger women − those between the ages of 40 and 49 − as they are to women age 50 and over. One in six breast cancers occurs in women under the age of 50. Independent research studies have estimated that waiting to start mammograms until age 50 could take the lives of an additional 6,500 women in the United States each year.

    Opponents of the task force’s 2009 decision claim the group’s motivation for late screening has been to save health care dollars. But, said Barbara Monsees, MD, chair of the American College of Radiology Breast Imaging Commission, “The bottom line is that discontinuing regular mammograms may save a few dollars in the short term but will result in thousands more breast cancer deaths each year. That human cost is too high.”

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    For more information, or to make an appointment with a UK HealthCare physician, please call UK Health Connection at 1-800-333-8874. 

Page last updated: 5/23/2014 2:54:04 PM
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    What the news means for you

    Mammography offers early detection and treatment

    Carol Dell, MD
    Radiology

    Wright, Heather, MDThe benefits of mammography for the detection and prevention of breast cancer have been recognized for decades. Mammography (also called a mammogram) is a very low-dose X-ray image taken of the breast. That image is analyzed by a radiologist or trained health care provider to help determine whether cancer is present. Mammography can be used for screening purposes − detecting early cancers before they can be seen or felt − and also as a diagnostic tool to assist providers in determining whether a lump is cancerous or benign.


    “We strongly encourage women with no known risk factors to begin screening mammograms at age 40.” 


    Thanks to better research and more accurate data, we know that diagnosing cancers of the breast in women younger than 50 is more difficult because of increased tissue density and rapid speed of disease progression compared with women who are over 50 or postmenopausal. Women in their 40s have the most positive outcome if cancers are detected and treated within a year; beyond that, survival rates decline sharply.

    Better studies point to age 40

    In the years following the 2009 recommendations set into place by the U.S. Preventive Services Task Force, additional high-quality studies have been published to further support mammography beginning at age 40. The task force’s team of epidemiologists considered the results of poorly researched, old data before making their recommendations and developed their guidelines from this information. The foundation of the group’s decision had a variety of flaws, including the lack of a radiologic expert who would have been able to provide valuable scientific and clinical knowledge about screenings.

    Health care leaders support screenings

    UK Radiology is pleased to see the AMA come over to the recommendations already supported by many cancer prevention groups. Our department strongly encourages women with no known risk factors to begin screening mammograms at age 40. High-risk women may begin screenings earlier, or at the discretion of the patient and her physician. Women who should consider earlier screenings include those with:

    • Personal history of cancer or noncancerous tumors.
    • Family history of breast cancer in a first-degree female relative: mother, daughter or sister.
    • Genetic defect (BRCA1/BRCA2 mutation).
    • History of radiation therapy to chest before age 40.

    Patient-physician communication is key

    Patients should speak with their physician about mammography and determine when they should begin screenings based on personal history and risk factors. If health care providers do not recommend a mammogram, patients should be prepared to request one or have a conversation with their provider to better understand why mammography should be delayed. Women who would like to have a screening mammogram may make an appointment any time and complete the test without a physician referral. Open conversations between the physician and the patient are important to the early detection of breast cancer. These conversations should include education about breast self-examination techniques and risk reduction through lifestyle modification.

    Dr. Dell is a board-certified radiologist and member of UK HealthCare’s breast cancer team. She is an assistant professor of radiology in the UK College of Medicine.


    Mammography, only better

    The UK Markey Cancer Center is the first in the state to offer tomosynthesis, a state-of-the-art imaging technique that makes the detection of masses in dense breast tissue more effective. Used in conjunction with digital mammography or alone, tomosynthesis is a form of mammography that analyzes breast tissue one layer at a time.

    Much like turning the pages of a book, the unit moves in an arc over the breast and produces digital images in slices to build a three-dimensional view of the breast. This data allows radiologists to look behind dense breast tissue to see the characteristics of a lump more clearly.

    Tomosynthesis has been shown to reduce call back rates for repeat screenings by as much as 30 percent and improves early cancer detection by 15 to 20 percent. UK HealthCare currently uses tomosynthesis as a diagnostic tool, but anyone may request a screening mammogram with tomosynthesis if they wish.

    To schedule an appointment for mammography or tomosynthesis, patients may call the UK Comprehensive Breast Care Center at 859-323-2222.

    Dr. Dell is an Assistant Professor of Radiology at UK HealthCare


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