When should women start breast screening, and how often
The news media almost never get it right. Twenty years ago they told us annual screenings starting at age 40 were the most beneficial. Then they said the age was 50 and over. Then they told us women only needed mammograms at two year intervals.
What’s really going on and why all the confusion?
The problem began in November, 2009 when the United States Preventive Services Task Force (USPSTF) issued new breast screening recommendations, which called for screening every two years for women aged 50-74 only. This was widely publicized in the news and online, and caused quite a stir within the medical community. Most breast health professionals did not agree with the recommendations, questioned the quality of data behind them and wondered why not a single breast cancer specialist was consulted before making the recommendation.
A USPSTF recommendation carries a lot of weight, and under the Affordable Care Act, insurance coverage is not guaranteed for services that fall outside the task force’s recommendations.
Unfortunately, the USPSTF has gotten it wrong on breast screening, and we in the breast health industry aren’t the only ones who believe that. Two years ago, Congress voted to place a moratorium on the USPSTF recommendations for breast screening, and just last week, a bipartisan commission voted to extend the moratorium. What all of this means is, at least for the foreseeable future, women 40 and older will still have insurance coverage for their annual screening mammograms.
It’s a mystery why the USPSTF still insists on releasing their recommendations, when clinical evidence clearly shows the benefits of annual screenings and starting with younger populations. In May of this year, the results of a study were released that showed that women aged 40-49, who had never undergone mammography screening and who were diagnosed with breast cancer had:
- Larger tumors
- A higher likelihood of cancer spreading to lymph nodes
- A higher likelihood of mastectomy and axillary dissection
- A higher likelihood of requiring chemotherapy
Other studies have shown that African-American women under 50 are at an even greater risk of developing breast cancer—including more aggressive cancers—and several advocacy groups are now recommending risk assessment and baseline mammograms for these women starting as early as age 30.
Clearly, the evidence supports mammographic screening beginning at 40 for most women and earlier for those at higher risk. The evidence supports annual—not bi-annual—screening to improve the chances for early detection. And the evidence shows that today’s advanced imaging equipment—like the kind we use at Neighborhood Radiology—is far superior at detecting breast cancer earlier, with fewer false positives and callbacks.
As always, the choice of when, where and how often to have a screening is up to you. We’re just happy you will continue to have the right—and the insurance coverage—to get screened every year starting at age 40.