By Jim Knaub
When should a woman have a mammogram? The catalyst of the current public flare-up in this ongoing debate is the recent New York Times article “Vast Study Casts Doubt on the Value of Mammograms” about results from the Canadian National Breast Screening Study (CNBSS) published in BMJ.
While that study questions mammography’s value, the medical community clearly has not reached an agreement on when women should begin screening mammography and how often they should have it once they start. Genetics, family history, and other factors ultimately play into this question.
This debate over mammography has been going on for a long time, but it became a more public debate when the US Preventive Serves Task Force issued its 2009 recommendation that most women should begin getting mammograms at age 50 and have them every two years, which is a significant departure from most related organizations’ recommendation of annual mammograms beginning at age 40. So who is correct?
“The mammography story is just not such an easy story,” Peter Juni, MD, a clinical epidemiologist at the University of Bern in Switzerland, told the Times.
That’s probably as good of an answer as there is available right now. Experts in this area of imaging balance the evidence of mammography’s record of reducing mortality against reports of overdiagnosis against unnecessary biopsies and treatment and reach different conclusions about who should be screened when. There is no single agreed-upon recommendation.
“It’s important for women to realize there is a genuine decision to be made here,” Lisa Schwartz, MD, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, said in a different Times article discussing the decision to undergo mammography.
While informed decision making is good, mammography advocates worry that a mixed message will become an unclear message that will keep many women from having mammograms, not because they make a conscious decision against the exam, but because the conflicting messages somehow promote inaction.
Additionally, mammography advocates and patients wonder whether government or commercial insurance regulators may use studies questioning the value of mammography as a reason not to cover the procedure. This hasn’t happened yet but remains a concern, which was voiced in part of the ACR’s response to the CNBSS: “The results of this BMJ study, and others resulting from the CNBSS trial, should not be used to create breast cancer screening policy as this would place a great many women at increased risk of dying unnecessarily from breast cancer.”
While it’s fair to say the medical community doesn’t agree on the issue, the mammorgraphy decision needs to remain a woman’s decision, not a regulator’s or insurer’s decision.
— Jim Knaub is editor of Radiology Today.