Andre Konski, MD, MBA, MA, FACR; Radiation Oncology
Fredric B. Squires, MD;, Radiology
Chester County Hospital; West Chester, PA
Published: April 14, 2014
A study recently published in the Journal of the American Medical Association (JAMA) has questioned the benefit of mammography in women 40-49 years of age. This study has caused considerable confusion among women and health care providers, especially since many professional medical organizations and societies, such as the American Cancer Society, have long maintained that women should have annual mammograms starting at the age of 40.
The JAMA study reported on research conducted by two physicians from the Brigham and Women's Hospital and Harvard Medical School in Boston, Drs. Pace and Keating. These two researchers reviewed all of the research papers published over the last 54 years in an attempt to identify possible benefits and harms of mammography and how to individualize screening decisions while promoting informed decision-making among women. The authors found mammography screening was associated with a 19% overall reduction of breast cancer deaths, while the risks of having a "false positive" (an abnormality was noted on the mammogram requiring further tests but did not ultimately prove to be a cancer) was about 61% in women aged 40-50 years old.
This demonstrates that screening mammography saves lives, but it is not perfect.
As recently as April 2, 2014 the Society of Breast Imaging responded to the article by stating, "To arrive at their recommendations, Pace and Keating ... placed too much emphasis on the obsolete low lifesaving benefit of mammography claimed in outdated or discredited studies. For instance, the Canadian National Breast Screening Study (CNBSS) has been widely discredited and should not be considered alone or in [the type of analysis used in] this JAMA article. The World Health Organization long ago excluded the CNBSS from its analyses of screening mammography's impact of breast cancer mortality. In a recent interview with CNN, the American Cancer Society echoed methodological concerns about the study. Breast cancer groups, such as BreastCancer.org, have criticized this study and warned against following the author's recommendations."
The Society of Breast Imaging's comments conclude with the following statements:
"Every major American medical organization with expertise in breast cancer care, including the American Congress of Obstetricians and Gynecologists , American Cancer Society, American College of Radiology (ACR), National Accreditation Program for Breast Centers and Society of Breast Imaging (SBI) recommend that women start getting annual mammograms at age 40. The ACR and SBI continue to stand by these recommendations."
ACR adds, "Mammography can detect cancer early when it's most treatable and can be treated less invasively -- which not only save lives, but helps preserve quality of life."
Mammography like all procedures has risks and benefits. The ultimate decision as to whether to have a mammogram or not should be made by the patient in consultation with her physician. Regarding annual screening mammography, we agree with the numerous professional societies above that women should start getting annual mammograms at age 40.
Reprinted with permission of the Daily Local News.
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