Annual mammograms after age 40 remains a good protocol

By Dr. January Lopez

Despite new recommendations, the facts remain clear: breast cancer kills and screening saves lives.

Self breast exams, clinical breast exams and yearly mammograms — for many women these tests are a mainstay of their breast care.

These long-standing recommendations are now threatened, leaving many women wondering how to be proactive about their breast health.

The American Cancer Society (ACS) in October introduced new breast cancer screening recommendations. For average-risk women, the ACS recommends yearly mammograms starting at age 45 — instead of 40 — and biennially over age 54. The ACS also recommends against clinical and self-breast exams.

These guidelines join a growing list of conflicting screening recommendations that frustrate women and health care providers alike.

Along with the National Comprehensive Cancer Network, American Congress of Obstetricians and Gynecologists, and American College of Radiology, Hoag Hospital remains steadfast in our belief that annual mammograms starting at age 40 are the standard of care.

The reasoning behind the disparate recommendations is complex. However, the following facts are fundamental to the debate over breast cancer screening:

1.) Breast cancer remains the second leading cause of cancer death in women.

2.) One in 8 women will develop breast cancer in her lifetime.

3.) Seventy five percent to 90 percent of women who develop breast cancer are at "average risk."

4.) Screening mammography significantly reduces a woman's risk of dying from breast cancer.

How much is a life worth? How accurate is the decades-old data on mammography? Which cancers don't kill? Who will develop cancer? These questions we cannot answer with certainty.

Risks and harms should always be considered. These include the potential for "over-diagnosis" of breast cancer, false positive mammogram results and financial burden. But when we couple the uncertainty and subjectivity surrounding the screening debate with the unmitigated fact that screening saves lives, the loosening of screening guidelines turns into a high-stakes gamble.

Aside from the cardinal focus on breast cancer mortality, early detection often results in breast-conserving surgery, better cosmetic results, lower treatment costs and potentially avoiding chemotherapy and radiation.

Mammography is not perfect. But two facts that cannot be overstated are that cancer kills and mammograms save lives.

So the next logical steps in the fight against breast cancer are to improve screening and focus on more effective and tailored treatments. Breast tomosynthesis, or 3D mammography, is a great leap in this direction and has been shown to increase the detection of invasive cancer by 40%, while simultaneously reducing the rate of false positives. Couple this with highly skilled, dedicated breast radiologists, and women experience less anxiety and fewer biopsies.

Tens of thousands of women will develop breast cancer between the ages of 40 and 44 this year. According to the ACS, most of them should forgo screening mammograms and any form of breast exam. How will these women be diagnosed? When their tumor is visibly deforming or when they develop headaches from metastatic tumor?

We have the tools that save women's lives. We should be using them. For more information, visit endtheconfusion.org.

Dr. January Lopez is the director of Breast Imaging at Hoag Breast Center.