Newspaper article International New York Times

Annual Mammograms Matter

Newspaper article International New York Times

Annual Mammograms Matter

Article excerpt

The American Cancer Society's new screening guidelines are wrong.

Last week, the American Cancer Society announced changes to its influential guidelines for breast cancer screening. The society no longer recommends that women at average risk between the ages of 40 and 44 have mammograms, and advises reducing the frequency of mammograms from every year to every two years for women 55 and older. The group also recommends ending physical breast examinations by doctors entirely.

We profoundly disagree with these changes. All three of us, two breast radiologists and one breast surgeon, have been named "Mothers of the Year" by the American Cancer Society in recognition of our work in the fight against breast cancer. One of us, Dr. Drossman, received her award just the day before the new guidelines were issued.

Because of our shared goals -- early detection of breast cancer, improved treatments and saving lives -- we were happy to support the cancer society. Now, we no longer wish to be involved.

Despite the changes, the society's website still states: "The American Cancer Society breast cancer screening guidelines are developed to save lives by finding breast cancer early, when treatment is more likely to be successful." Mammography in all age groups, starting at 40 years old, is the only test that has been proved to reduce the risk of dying from breast cancer, by up to 30 percent.

Today, the overall survival rate for breast cancer in the United States is close to 90 percent, the highest it has ever been. Early detection with mammography and better treatment options are both directly responsible for that.

It's not just a matter of saving lives. There are other important benefits of early detection by mammography. For example, women with cancers detected at smaller sizes are much more likely to be able to have a lumpectomy and less disfiguring surgery. In addition, the smaller the cancer, the lower the likelihood that the disease may have spread to lymph nodes and elsewhere. In turn, this means less likelihood of needing aggressive treatment like chemotherapy and radiation.

A further problem with the new guidelines is that increasing the interval between screenings for women over 55 will result in delayed diagnosis and larger tumors. This will lead to more extensive and potentially expensive treatment.

We agree that mammograms are not perfect; there is no ideal test for detecting any type of cancer. False positives occur in screening tests of all kinds. Let's stop overemphasizing the "harms" related to mammogram callbacks and biopsies.

In breast cancer screening, most false positives -- when a mammogram suggests something that requires further investigation -- are easily resolved with additional images that put the concern to rest. Only 2 percent of screening cases require a biopsy. …

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