Ladies! This Costly Procedure Is More Harmful Than Useful
The American Cancer Society has issued major changes in their recommendations on breast cancer screening, saying women should have mammograms less frequently and start having them later in life. These new guidelines reflect a growing body of evidence that mammography is less useful to younger women than previously thought, and that too-frequent testing could have negative consequences. In fact, studies show the previous mammography recommendations may have some serious drawbacks, including false positives, unnecessary testing and biopsies, and overdiagnosis.
The new ACS guidelines, issued on October 20, say women with an average risk of breast cancer should have mammograms every year from the ages of 45 to 54, and every other year from age 55 on. This is a significant change from the previous guidelines, which said women should start having mammograms at age 40 and have them annually thereafter.
The change in mammography recommendations is a response to evidence accumulated since the previous recommendations were issued in 2003. Long-term follow-up of randomized controlled trials and observational studies of organized, population-based screening indicate that the potential drawbacks of more frequent screening outweigh the possible benefits, particularly for women under 45.
False positives, common in breast cancer screening, can lead to unnecessary additional testing and in some cases may result in unneeded biopsies. According to the Journal of the American Medical Association, studies show that women who have annual mammograms have a 61.3% chance of experiencing at least one false positive result after 10 years of screening, but with mammograms every other year that probability drops to just 41.6%. The probability of a false positive mammogram leading to a biopsy was 7.0% with annual screenings, which dropped to 4.8% with screening every other year.
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Studies on overdiagnosis also impacted the new recommendations. Overdiagnosed cancers, or screen-detected cancers that would not have led to symptomatic breast cancer if undetected by screening, are a consistent problem associated with mammograms. The estimates of overdiagnosis vary widely, from as little as 5% to as much as 50%, but the new recommendations recognize that overdiagnosis is a serious potential negative of frequent screenings because it results in overtreatment.
New study-based evidence on the effectiveness of screening for younger women also played a role in the change in the age at which ACS recommends that women start having mammograms. Estimates of the risk of at least one false positive result were found to be consistently higher when screening began at younger ages.
But though the recommendations for mammograms have changed, the ACS stresses that women should have the opportunity to have the test earlier than age 45 if they choose, and they should also have the option of continuing annual mammograms after age 55. The ACS says the age at which mammograms begin and the frequency with which they’re performed is a matter that must be determined by each woman and her doctor.