The New Mammogram Guidelines: What do They Mean for You?

A government advisory panel created controversy and confusion last year when it revised long-standing directives designed to detect breast cancers in their earliest stages. In November of 2009, the U.S. Preventive Services Task Force, a group that provides guidance to policy makers, doctors and insurance companies, suggested women start getting screening mammography at 50 instead of 40. It also advised the test be done every two years instead of annually.
"We were all stunned by the recommendations,” said Carol Kronenwetter, a licensed psychologist who leads the Breast Cancer Recovery Program at the Breast Health Center on CPMC’s California Campus. “I believe these guidelines are sending the wrong message to women and turning some away from getting screened at all."

Risks v. Benefits

The task force did not negate that early detection saves lives. On the contrary, it acknowledged that the decrease in breast cancer deaths since 1990 is largely attributed to the combination of mammography screening and improved treatment. The task force even said the x-ray exam reduces the risk of dying from breast cancer by 15 percent in women 39 to 49.
The government advisory panel called into question false positive test results – which occur more often in younger women. Using a computer model that took into account the medical data and assumptions about breast cancer diagnosis and treatment, it concluded that screening for the disease too early and too often can lead to false alarms, needless anxiety and unnecessary biopsies. The potential harms, the panel determined, exceeded the proven benefits for women in their 40s.

Guidelines Find Few Fans

Very few agencies have changed their screening guidelines based on the panel’s recommendation, including the American Cancer Society (ACS). It has maintained the paramount importance of early detection, insisting the benefits of annual mammography screening for women in their 40s far outweigh the potential harms.

Jessica Leung, MD, chief radiologist at the Breast Health Center on CPMC’s California Campus, agrees with the ACS. "Certainly more lives would be saved if screening mammography is performed every year starting at age 40 - and not age 50. The debate centers on costs, particularly the costs of false-positive examinations," said Jessica Leung, MD, chief radiologist at the Breast Health Center. "I believe that we as a medical community can work together to reduce false-positives. Therefore, I continue to recommend annual screening starting at 40."

Anecdotes & Evidence

"I see breast cancer survivors every day who are still here because of early detection," said Mary Catanzaro. Lead technologist in the Breast Health Center at CPMC’s St. Luke's Campus, she performs mammograms. "In January alone, we had eight women diagnosed with breast cancer. Three were in their 40s."
Statistics back up her anecdotal experience. The most significant increase in breast cancer rates occurs at age 50 and up, but women in their 40s aren’t far behind. Looking back at breast cancer diagnosis’ data between 2002 and 2006, the National Cancer Institute reported the following:

• 23.7% were between the ages of 55 - 64


• 22.5% were between the ages of 45 – 54


• 10.5% were between the ages of 35 - 44

"Women younger than 50 can and do get breast cancer all the time," said Kronenwetter. Nineteen years ago, at the age of 43, she had a bilateral mastectomy after being diagnosed with the disease. "The task force’s advice doesn’t fall in line with best practices and it doesn’t consider the individual. The computer model that is used to reach those conclusions can’t measure the value of a human life."

Penny’s Plight

Penny Paunovich agrees. She is neither pleased with the new guidelines, nor among an age group that’s considered at high risk for the disease. At 38, the Oakland resident felt a lump in her breast.

"It was impossible to ignore because it was terribly painful," she said.
Paunovich went to the Breast Health Center at CPMC’s California Campus where a diagnostic mammography identified a suspicious mass. It was a tumor. A surgeon performed a lumpectomy. A pathologist determined she had stage III breast cancer. Paunovich survived, but chemotherapy alone wasn’t enough to kick her cancer. The disease kept spreading. She endured a double mastectomy followed by radiation therapy.
"When a woman waits for a mammogram until she has a palpable mass, we find that it is larger and at a more advanced stage requiring more aggressive surgery and treatments," said Catanzaro.
Less than one year later, Paunovich is now a breast cancer survivor. Two days before she began chemotherapy, she got married.

"My boyfriend wanted me to know he was in it for the long haul, so he proposed after we learned of my diagnosis," she explained. "I wanted to have hair for my wedding, so we set a date before the chemotherapy started."

Now a wife and a mother of three step-children, she has strong opinions about breast screening, and wise words for other women.

"Listen to your body," she asserted. "Don’t ignore the signs. Get care right away if you feel or see something abnormal in your breasts." Breast awareness can reduce your risk of dying of breast cancer, but so can early diagnosis. In fact, the majority of new breast cancers are caught as a result of an abnormality seen on a mammogram. Talk to your doctor to find out when and if a yearly screening is appropriate for you. Depending on your genes and family history, you may need to follow a different breast cancer screening schedule – one that’s established by you and your physician, not a government advisory panel.