The most recent recommendation from the U.S. Preventive Services Task Force is that all women ages 40 to 74 get a mammogram every other year. An earlier recommendation said screening should begin at age 50. One doctor suggests that people “test smarter, not more often.”
Heather Charles/Tribune News Service via Getty Images
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Heather Charles/Tribune News Service via Getty Images
New research calls for women in their 40s, who have been embroiled in a decades-long debate over whether to get mammograms to screen for breast cancer, to be informed about the harms and benefits of the test.
After a nationally representative sample of U.S. women ages 39 to 49 were told the pros and cons of mammography, more than twice as many chose to wait until age 50 to get screened, according to a study published Monday in the journal. Annals of Internal Medicine found it.
Most women have absorbed the widespread message that screening mammography saves lives by the time they reach middle age. But many remain unaware of the costs of routine screening in their 40s – in false-positive results, unnecessary biopsies, anxiety and grueling treatments for tumors that would do no harm if left alone.
“In an ideal world, all women would get this information and then have their doctor answer any further questions they have and create a screening plan that’s right for them, given their preferences, their values and their level of risk,” said social psychologist Laura Scherer, lead author of the study and an associate professor of research at the University of Colorado School of Medicine.
Of the 495 women surveyed, only 8 percent initially said they wanted to wait until they were 50 to get a mammogram. After researchers informed the women about the pros and cons, 18 percent said they would wait until they were 50.
“We are not honest”
The study found that women who were aware of the disadvantages of mammograms did not deter them from having the test at some point.
The benefits and harms of mammography came as a surprise to nearly half of the study participants. More than a quarter said what they learned about overdiagnosis from the study was different from what their doctors had told them.
“We’re not being honest with people,” said breast cancer surgeon Dr. Laura Esserman, director of the University of California, San Francisco Breast Care Center, who was not involved in the study.
“I think most people are completely unaware of the risks associated with screening because we’ve had a public health campaign for 30, 40 years: Go out, get your mammogram and you’ll be fine,” she said in an interview with NPR.
Esserman sees women diagnosed with slow-growing tumors that she thinks will probably never harm them. Plus, mammography can give women a false sense of security, she said, as it did for Olivia Munn.
The 44-year-old actress had a clear mammogram and a negative cancer gene test just before her doctor calculated her lifetime risk score for breast cancer, raising red flags and leading to treatment for fast-growing, aggressive breast cancer in both breasts.
Towards a personalized screening plan
Esserman advocates for a personalized approach to breast cancer screening like the one that led to Munn’s diagnosis. In 2016, she launched the WISDOM study, which aims to tailor screening to a woman’s risk and, in her words, “test smarter, not test more.”
The National Cancer Institute estimates that more than 300,000 women will be diagnosed with breast cancer and 42,250 will die this year in the U.S. Incidence rates have been increasing about 1 percent per year, while death rates have been decreasing just over 1 percent per year.
The influential U.S. Preventive Services Task Force has changed its position over the past 28 years about when women should begin mammography screening.
From 1996 to 2002, the independent panel of volunteer medical experts who help doctors, insurers and policymakers guide women’s health said they should begin screening in their 50s. In 2002, the task force said women in their 40s should get screened every one or two years. In 2009, it said women in their 40s should decide whether to have a mammogram based on their medical history and individual preferences.
The new research was conducted in 2022, while the task force guidelines called for women in their 40s to make their own decisions.
New guidelines
In 2024, the panel again said all women ages 40 to 74 should get mammograms every other year. Rising breast cancer rates among younger women and models showing how many lives screening could save, especially among black women, have fueled the push for earlier screening.
An editorial accompanying the new study emphasized the need for education about mammography and the value of shared decision-making between clinicians and patients.
“To make an informed decision,” said the editorial written by Dr. Victoria Mintsopoulos and Dr. Michelle B. Nadler, both of the University of Toronto in Ontario, “the dangers of overdiagnosis – defined as the diagnosis of asymptomatic cancer that will not cause the patient future harm – must be communicated.”