“If I choose to get a mammogram, how often?”

Hello bOObs Bloggettes:

Thanks for all the interest in my last blog on cancer and sugar intake. I’ll blog more on preventative cancer measures, etc., in the future. Today, I’d like to blog about mammography again to discuss what researchers/decision-makers are saying about screening frequency both in the U.S. but more importantly in the E.U.

Based on research and meta-analyses that came to light in the medical literature over a decade ago, entities such as the American Cancer Society (ACS) and the US Preventative Services Task Force (USPSTF) changed their breast cancer (BC) screening guidelines. But women (and the media) were left very baffled by this development. It wasn’t made clear as to why this occurred. I’ve covered this some in previous blogs on screening guidelines, but I’m going to go a little deeper here.

We discussed in a previous blog that in 2009 the U.S. BC screening guidelines changed, advising women to get screened every other year at certain ages. This was due largely to over-diagnosis of the pre-cancerous Stage 0 DCIS (see previous blog on this) but also because two important studies showed there were no lives saved overall for women in their 40s (in other words, as many women were being harmed by mammograms as were being saved).

In addition, radiating the breast year after year (not to mention inflaming the tissue via compression) was also concerning. In my humble opinion, that’s the most important factoid to be concerned about because the dense breast tissue (DBT) we all have is the most radiation-sensitive in the body and the radiation in mammograms is a lot higher than reported. Repeatedly exposing this DBT to radiation, the cell physiologists are saying, is a terribly bad idea (see previous blogs). In addition, more and more research is coming to light saying that mammograms’ radiation is inducing BC more often than previously thought.

The USPSTF set the wheel in motion of changing the guidelines based on its own review of the literature and came up with the dramatic change of not recommending screening until age 50 — which shocked the screening world, along with doctors and patients. The dominoes scattered from there and repercussions were felt everywhere around the world.

I was astounded to find out that the EU’s guidelines — which were based on the EU’s own research review of the literature — are totally different than ours here in the US and make a heckuva lot more sense in several areas (but not in all areas). Let’s look closer.

The EU guidelines, published on 10/24/19, pertain to screening women ages 40 to 75 years who are at average risk for breast cancer and address: 3D mammography and the addition of hand-held ultrasound; automated breast ultrasound (known as ABUS); and MRI. These devices are all held up against using mammography alone. The EU also looked at screening frequency and average-risk women with suspicious lesions or with high breast density.

The EU’s guidelines differ than the recommendations in the U.S. in that the EU really looked at screening from different angles and took in many considerations. The U.S. simply looked at how often one should get screened with mammography. So while the US guidelines did change somewhat, nothing really changed with regards to screening devices at all.

Specifically, in the EU:

— Screening is not suggested for women ages 40 to 44 years; this is due to the studies showing no decrease in mortality for this age group; in other words, no saving of lives via screening; digging into the research that this was based on, the researchers were concerned about over-diagnosis of pre-cancers (e.g., DCIS) and radiation-induced cancers in younger, denser breasts of women 40 to 44.

— For women 45 to 74 years, screening is suggested every two to three years (note that the US doesn’t recommend putting off screening for three years for any age group).

— For women ages 70 to 74 years, the guidelines recommend screening every three years.

— For ages 74+ screening isn’t recommended at all. (Incidentally, here in the U.S., the American Cancer Society recommends women should keep screening basically until the grave, but the USPSTF says this: “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older.” We will look into why this might be so in the next blog.)

— THIS IS A BIG ONE: Tailored screening with automated or hand-held breast ultrasound or MRI is not suggested for women with high breast density tissue (DBT).

— THIS IS AN EVEN BIGGER ONE: 3D mammography is not recommended for use as a primary screening tool; instead, the guidelines suggest that 3D mammograms (rather than diagnostic 2D mammography) be used as a follow-up test for women who have suspicious lesions on their original screening mammogram. Here in the U.S., the USPSTF is not convinced we should be using 3D either as a primary screener: “The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of [3D mammography] as a primary screening method for breast cancer.”

So the EU guidelines, in my opinion again based on my own research, make sense in that they recommend: 1) not using 3D mammograms as a primary screening device for all women but rather as a follow-up diagnostic test; and 2) changing the screening schedule to two and even to three year intervals for all age groups.

However, not using ultrasound for women with dense breasts doesn’t make any sense at all to me. These women should be allowed the choice between ultrasound and mammography, based on a conversation women have with their doctors and/or whether they want to avoid radiation on their radiation-sensitive breasts. It’s most likely that the EU was trying to avoid more over-diagnosis of BC but also to save insurance company money (they mention the latter).

BOOBS BOTTOM LINE: If you do decide to go with mammography as your screening device, you might want to discuss with your doctor what the EU is recommending to its patients first. Here’s the actual study link you can show them: https://www.acpjournals.org/doi/10.7326/M19-2125?_ga=2.81324439.1467528902.1647892626-48822390.1647892625

And of course understand all the pros and cons of your screening device by doing your research and asking questions of your doctors.

Blog at you soon, thanks for reading and helping to spread the word!  (Please see the “share” links below.)  And we’d love to hear comments from you! (see below as well)

Stay healthy,

Megan

Megan Smith, M.S.
Director, bOObs: The War on Women’s Breasts

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