The importance of annual mammograms

Recent trends in women’s health started a significant debate: how often should women, based on age and risk factors, get a screening mammogram?

Our Position

Regional Medical Imaging recommends annual screening mammograms for women starting at age 40 as part of their routine wellness care. We further recommend women ages 20-39 should perform monthly breast self-exams, reporting any lumps or changes to their primary care provider immediately and get regular clinical exams.

In addition, we recommend women with increased cancer risk and/or dense breast tissue start annual mammograms before age 40, and consult with their physician regarding additional screenings.

The latest clinical research about annual mammograms shows that:

Annual screening starting at 40 reduces mortality by nearly 40%–compared with just 23.2% for biennial (every other year) screening¹
Women in their 40s account for nearly 20% of all screen-detected breast cancers²
In a single year, if every woman 40 years of age and older had annual mammograms, there would be 29,369 lives saved¹
Screening mammograms should be also performed annually in older women, until the age of 84¹
African American women and women of Ashkenazi Jewish descent are at a higher risk for breast cancer, and should have a breast cancer risk assessment at age 30 to determine if annual mammograms should begin before 40 years of age.³
The American College of Obstetricians, The American College of Radiology, The Society for Breast Imaging and the American Society of Breast Surgeons all agree… screening mammography starting at age 40 for women at low or average risk is best, and possibly earlier for women at high risk.

Sources:

Cancer 21 August 2017 Comparison of recommendations for screening mammography using CISNET models. Elizabeth Kagan Arlea MD et al.
American Journal of Roentgenology. Voume 209, Issue 3 September 2017. Screening Mammography for Women in Their 40s: The potential impact of the ACS and USFSTF breast cancer screening recommendations. Jenifer A. Pitman, et al.
American College of Radiology recommendation

How Did the Debate Start?

In 2009 and again in 2015, the U.S. Preventative Services Task Force (USPSTF) issued guidelines calling for screening mammograms every two years (instead of annually) for women ages 50 to 74 (instead of age 40+). The announcement generated a lot of media interest, follow-up studies, and debate.

Who is the USPSTF?

The USPSTF is an independent panel of primary care physicians and epidemiologists that systematically reviews the effectiveness of clinical preventative services and issues recommendations for improvement. The U.S. Department of Health and Human Services funds the panel.

What specifically did the USPSTF recommend?

Women ages 50-74 at average risk for breast cancer should undergo screening mammography every two years.
Women younger than 50 should make individualized screening decisions, weighing the benefits versus harms of screening.
There is insufficient evidence to recommend for or against screening women 75 or older.

This is in contrast with the USPSTF’s recommendations prior to 2009, which called for annual mammograms.

What are the criticisms of USPSTF recommendation?

Critics of the USPSTF recommended guidelines cite numerous problems with the data gathered, the resulting analysis, and the final conclusions. Detailed criticism cites the data is based on computer modeling and estimates instead of randomized double-blind study methods, a lack of expert opinions from breast imaging and breast cancer experts, disagreements with how ductal carcinoma in situ (DCIS) is regarded by the study, a lack of attention to newer screening technology, and an age vs. family history bias.

Early Detection is Key to Survival

Statistics compiled by the National Cancer Institute and Centers for Disease Control and Prevention cite there were 136.5 incidences of breast cancer per 100,000 women in Oakland County in 2015 with 124.7 in Genesee, and 103.7 in Lapeer County. Put another way, that means 1.36 of every 1000 women develop breast cancer in Genesee County each year.

Breast cancer is the second-most common cause of cancer death for women in the United States, with lung cancer being first. However, the key to survival is detection. Early detection has changed the five-year survival rate to 89%, while the 10-year is 83% and 15-year is 78%. Obviously, these survival numbers decrease the longer breast cancer remains undetected and untreated.