Mammography Facts

Most important Action: Get Your Mammogram
Most important question: WHO is reading the Mammogram?

Breast cancer is a curable disease with greater than 95% survival if diagnosed in its earliest forms. Therefore, it is critical to diagnose breast cancer as early as possible in order for women to achieve the goal of a cure. Mammography, physical examination by a health care provider, and breast self-examination, remain the mainstay of breast cancer screening. All three components are important.

Mammography is an x-ray examination that evaluates the breast. It uses the smallest amount of radiation, less than that obtained when flying transcontinentally. It is a well-accepted and effective method of diagnosing early stage breast cancer. Numerous studies have shown the UNEQUIVOCAL and large effect of improved survival in women who get mammograms, especially if they obtain routine examinations every year. It is the change in mammography that allows the radiologist to diagnose the earliest breast cancer.

The effectiveness of Mammogram as a diagnostic tool increases when it is evaluated by a dedicated breast imager. Ask whether the radiologist reading your mammogram devotes 80% or more of their time to reading mammograms.

Dr. Brem's Response to USPSTF Recommendations

There is universal agreement that mammography saves lives. For the past 20 years the DEATH RATE FROM BREAST CANCER HAS DECLINED by 30%, more in younger woman. This decrease in death rate is due largely to the increased use of mammography.  With this overwhelmingly compelling data, why then did the United States Preventive Services Task Force (USPSTF) issue new, dangerous recommendations to deny mammography to women in their 40’s, screen woman between the ages of 50 and 74 once every other year and recommend against screening woman above age 74.  Their “analysis” did not use any direct scientific data. They chose to ignore modern, compelling clinical trials that demonstrated a 40% reduction in breast cancer deaths and rather based their flawed recommendations on old data and mathematical models. Their analysis is flawed and seriously underestimates the impact of mammography on saving lives. 

Even the USPSTF acknowledges that mammography saves lives. However, their conclusion is that is does not save enough lives to justify the cost and the potential harm.  What harm are they referring to? The anxiety of a positive result, the performance of additional test to confirm or exclude the possibility of cancer and the slight increase in the number of breast biopsies performed. Finally the USPSTF is concerned with “overtreatment” in that today we cannot differentiate which cancers will become deadly and which will not.  The hope is that in the future we will benefit from additional research to make this distinction.  However, until that time we have the medical and  moral responsibility to treat all women with breast cancer to optimize their chance for survival. These minor inconveniences are a small price for the possibility of finding an early, curable, breast cancer.  As a woman, a breast cancer advocate and a breast cancer survivor, I know few, if any, women who would opt for the “convenience” of forgoing a mammogram and losing the opportunity for a cure.

The USPSTF recommends using a woman’s risk of breast cancer to determine if she should have a mammogram between the ages of 40-49.  However, over 70% of women with breast cancer have NO risk factors.  Not screening woman at normal risk will result in missing 75-90% of breast cancers. Furthermore, their recommendations contradict the biology of breast cancer which is more aggressive and  faster growing in younger woman. There is no magical change in a woman at the age of 50. Therefore, comparing woman 40-49 with a much wider age group, i.e. 50-74, is unscientific and pure data manipulation.  Furthermore, the incidence of breast cancer in woman in their 40’s is only slightly less than woman in their fifties. These age groups deserve the benefits of mammography and denying that would amount to nothing less than reversing the reduction in breast cancer mortality we have achieved in the past 20 years.

The USPSTF is a federal government funded committee with no medical imaging representation. If these flawed recommendations are adopted by Medicare and private insurers as a justification to deny life-saving medical examinations, American woman will unnecessarily die of their disease.  This attempt at cost reduction will result in the far greater, deadly cost, of denying lifesaving opportunities to American woman. The American Cancer Society and the American College of Radiology are refusing to go along with these recommendations and are maintaining their recommendation, which is based on all available scientific data, to recommend annual screening mammography for all  women 40.  It is critical, to follow these recommendations the recommendations of the American Cancer Society and continue to support and advocate for mammographic screening for all woman aged 40 and above. The recommendations of the USPSTF is nothing less than a travesty!  Let us do all we can not to trade cost cutting measures for life saving opportunities.