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Screening Mammography Facts (ages 40-49)


We want you to be informed about the benefits of screening mammography and our position on when to start being screened. However, we encourage you to talk with your physician to determine the most appropriate course of wellness and screening steps to fit your needs, based on your age and family history. Below are some facts to consider.

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ACS Recommendations for Early Detection


Charlotte Radiology and most cancer experts support the American Cancer Society guidelines for breast cancer screening in women 40 years and older. The use of screening mammograms, clinical breast exams, and MRI for high risk women offer the best chance for early detection, simplified treatments, and reduced breast cancer mortality.

Current American Cancer Society (ACS) guidelines provide:

  • Women 40+ should have a screening mammogram every year and continue to do so for as long as they are in good health.
  • Women in their 20's and 30's should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional, at least every 3 years. After age 40, women should have an annual breast exam.
  • Women in their 20s may wish to begin monthly breast self examination. Women should be told about the benefits and limitations of BSE. Women should promptly report any breast changes to their health professional.
  • Women with greater than 20% lifetime risk of breast cancer (based on family history, genetics testing, prior atypical pathology, previous thoracic radiation therapy and other factors) should get an MRI and a mammogram every year. Women at moderately increased lifetime risk (15 - 20%) should talk with their doctors about the benefits/limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk is less than 15%.

Task Force Recommendations


In November 2009, the U.S. Preventive Services Task Force (USPSTF) announced new recommendations for women regarding screening mammography. This report suggested that women age 40-49 no longer need to be screened for breast cancer and that women over 50 only need screenings every second year.

After a loud outcry nationally from both physicians and cancer organizations, a Senate committee questioned the Task Force regarding the study. On December 3, 2009, the Senate amended the healthcare reform bill to ensure that insurance companies do not use these recommendations as a basis for limiting mammography coverage. However, in subsequent months countless news stories repeated the controversial recommendations, ultimately confusing women and their physicians about screening mammography.

A mere three months after the initial Task Force recommendations an Avon Foundation survey found that at least 10 states reported reductions for cancer screening programs and services for women under 50. Additional surveys have reported nationally declining screening mammography compliance trends.

Statement Regarding Task Force Recommendations


Several local medical experts have collaborated to issue the following joint statement in response to the U.S. Preventive Services Task Force's new recommended guidelines for mammography.

As breast cancer and women's health experts we feel it is important for women to continue following screening recommendations from the American Cancer Society, including scheduling annual mammograms beginning at age 40. We do not support the recent recommendations presented by the U.S. Preventive Services Task Force and feel their findings are not in the best interest of women's health.

Signed:

  • William K. Poston, Jr., MD, President, Mecklenburg County Medical Society
  • E. Winters Mabry, MD, Health Director, Mecklenburg County Health Department
  • Richard B. Reiling, MD, FACS, Medical Director, Presbyterian Cancer Center
  • Frederick L. Greene, MD, FACS, Chairman, Department of Surgery, Carolinas Medical Center
  • Nicole Abinanti, MD, Director of Women's Imaging, Mecklenburg Radiology Associates, Presbyterian Breast Center
  • Arl Van Moore, Jr., MD, President, Charlotte Radiology

Flaws in the Task Force Study


Many cancer experts and organizations, including the American Cancer Society, believe the Task Force report is seriously flawed. We have briefly outlined some of the deficiencies in the Task Force report for your review:

  • No breast cancer experts were included on the review panel (such as breast surgeons, oncologists, & radiologists).
  • The panel used data from older and poor quality studies, dating back to the 1960's. Many studies included poor mammography techniques (e.g., one-view mammograms), improper randomization procedures, or had insufficient statistical power to assess age-related benefits. The Task Force did no critical analysis of the studies and their limitations. The gains from improved clinical mammography in the U.S. due to regulations promulgated under the Mammography Quality Standards Act of 1992, as well as from the adoption of digital mammography, were not recognized.
  • The Task Force did no direct research, but used statistics and computer modeling to estimate screening mammography benefits at various ages. This approach is less reliable than the "gold standard" used for most medical research - a randomized, double-blind study measuring actual outcomes. The Task Force's conclusions directly contradict those of many carefully designed clinical trials.
  • The Task Force acknowledged that screening women 40-49 saves lives, but stated it is "less efficient" since cancer is more prevalent in women over 50. No cost-benefit analysis or other objective assessment of benefit was done to justify discontinuing screening in women 40-49. Furthermore, the Task Force's conclusions were based only on the metric of reduced mortality -- not life-years saved - even though its own data showed that screening the 40-49 age group achieved a 29% reduction in life-years lost.
  • The Task Force suggests screening women under 50 only if they have a family history of breast cancer. However, approximately 75 - 80 percent of women diagnosed with breast cancer have no family history. Limiting screening to those with risk factors will miss the majority of breast cancers.
  • The Task Force measured only one benefit of screening - decreased mortality - and ignored the other important benefits of screening mammography. As you aware, early detection allows for simpler surgery, greater breast preservation, reduction of lymph node dissection, and lessens the need for chemotherapy.
  • The Task Force overstates the "harms" of screening mammography, citing anxiety and inconvenience caused by additional imaging following indeterminate screens, and from biopsies which may prove benign. This conclusion is extremely subjective and was not weighed against the "harms" of being deprived of cancer screening or the burdens, anxiety and costs to women who develop clinically-apparent, later-stage cancer requiring more extensive treatments.
  • The Task Force did not correct the media when they mistakenly reported that 1,904 women must be screened to save one life. The number 1,904 was determined by the number of women invited, not the number of women screened. The correct number to screen in the 40-49 age-group to save one life is between 726 and 952. This accurate figure derives from women who actually got mammograms in Swedish and British Columbia studies -- not from those merely "invited" to get mammograms but who may or may not have gotten them. Also, the women who were actually screened had a 30-40 percent mortality reduction, not the 15 percent reduction used by the Task Force for those invited.

Local Facts from a Nationally Recognized Provider


As Charlotte Radiology is one of the largest breast cancer screening programs in the country, we reviewed our own data to provide a local perspective. From June 1996 - December 2008, Charlotte Radiology performed nearly 625,000 screening mammograms. Of the breast cancers detected in our screening program, 21.4% were found in women ages 40-49. Breast cancer risk rises with age, but our 40-49 group had two-thirds the incidence of cancer compared to the 50-59 group (2.5 compared to 3.8 per thousand screens). These data are consistent with national statistics and confirm that age 50 is not a threshold for cancer.

40% of life-years lost to breast cancer is in women who were diagnosed in their 40s. Nationwide, mortality rates from breast cancer have decreased by 30% since 1990 due to mammography screening and improved treatments. This progress would be threatened by curtailing screening of women 40-49, or by decreasing the frequency of screening women over 50.

Breast Cancer Fast Facts


  • Screening mammography has reduced the mortality rate by 30% since 1990.
  • 75-80% of women with breast cancer have NO family history.
  • Breast Cancers detected in women under 50 are often the more aggressive cancers.
  • 1 in 8 women is affected by breast cancer in their lifetime
  • The two biggest risk factors for breast cancer are being a woman and growing older.
  • Mammography is a low-cost and safe tool for breast cancer screening, with the amount of radiation exposure comparable to flying across the country.
  • Breast cancer is the second leading cause of cancer deaths in women today (after lung cancer) and is the most common cancer among women, excluding non-melanoma skin cancers.

Want More Information?


For more information, please contact Shawna Platé, Marketing Manager for Breast Services, at 704-334-7811.

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