UAB Sounds off on what age to get a mammogram

BIRMINGHAM, AL (WAFF) - The University of Alabama at Birmingham (UAB) Comprehensive Cancer Center strongly supports the recommendations of the American Cancer Society that women should begin mammography screening at age 40 and continue on an annual basis as long as they are in good health, says Edward Partridge, M.D., center director.

"The take-away message is that each woman needs to consider her individual benefits and risks and discuss them with her health care provider when it comes to decisions about breast cancer testing and screening," Partridge says.

His comments came after the announcement of the U.S. Preventive Services Task Force (USPSTF) decision to push back its guidelines on initial mammograms to age 50 and conduct follow-ups every two years.

Recommended annual mammography and clinical breast examination for all women beginning at age 40 is the best advice, says Helen Krontiras, M.D., co- director of the UAB Breast Health Center and a scientist at the UAB Comprehensive Cancer Center.

"Mammography is a screening tool, and it is the best screening tool that we have right now," Krontiras says. "It is minimally invasive, it is cost-effective, and it really has very few, if any, side effects.

"Mammography does not prevent breast cancer from happening, but it tries to find breast cancer early – when it's treatable and when it's curable," she says.

Otis W. Brawley, M.D., chief medical officer of the American Cancer Society, says his group reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, he says, reasonable experts can look at the same data and reach different conclusions.

In 2003, an expert panel convened by the American Cancer Society conducted an extensive review of the data available at the time. Like the USPSTF, the society's panel found convincing evidence that screening with mammography reduces breast cancer mortality in women ages 40-74, with age-specific benefits varying depending on the results of individual trials and other analysis.

Like the USPSTF, the American Cancer Society panel also found that mammography has limitations – some women who are screened will have false alarms, some cancers will be missed, and some women will undergo unnecessary treatment. These limitations are somewhat greater in women in their 40s compared with women in their 50s, and somewhat greater in women in their 50s compared with women in their 60s.

"But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives," Brawley says. "As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member."

The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group, yet screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile.

The UAB Comprehensive Cancer Center, the American Cancer Society and numerous other professional and advocacy groups feel that in both cases, the lifesaving benefits of screening are worthwhile. Surveys of women across the nation and in Alabama show they are aware of mammography's limitations, but that they also place high value on detecting breast cancer early, Krontiras says. Screening technology is improving as well.

As Brawley says, "Data show the technology used today is better than that used in the studies in this review, and more modern studies show that mammography is achieving better results than those achieved in these early experimental studies that go back as far as the mid-'60s."