Why BC Screening Recommendations Changed in 2009

Hello bOObs Blogettes:

You might be surprised to learn this (I was) but the American Cancer Society’s chief medical officer has said this: “Mammography is a suboptimal test…We need a better test.” So why would a VP of the ACS say such a thing during our 2016 interview? We’re about to find out.

Breast cancer (BC) screening has been controversial from the get-go. First, some researchers were pointing out their concern for radiating women year after year. Then various studies pointed out that premenopausal women (ages 40-50), whose breasts are denser, were more likely to get radiation-induced cancer from mammography so screening shouldn’t really begin until age 50 or so. In fact, some studies discovered that mammography was hurting as many women as it was “saving” in that age category. But those who had a vested interest in mammography kept up their roar and basically won the fight that women should begin at 40 — and in addition, they should get a baseline at 35 (which I unfortunately had way back when).

The debate started to heat up again when one of the most respected research groups in the world, the Nordic Cochrane Centre, got involved and eventually carried out a mega-analysis on all of the various prominent BC screening studies. Their conclusion questioned the need for mammography at all as it was indeed harming many, many women. In fact, one of the founders of Cochrane said this in the Lancet medical journal in 2000: “We conclude that screening for breast cancer with mammography is unjustified.”

While some of the debate centered around radiation of dense breast tissue in younger women, the rest centered on “Stage 0” Ductal Carcinoma in Situ (DCIS). You can read my previous blog on this for details, but suffice to say that DCIS, a precancerous condition, was being vastly over-diagnosed and hence women were getting needless treatments such as mastectomies and radiation prophylactically.

Therapeutic radiation is obviously not something to undergo unless absolutely warranted as it can induce cancer in the patient years later. But mastectomies are also not without risk. I cranked the numbers I found in one research paper and ended up with this: 1 in 400 women who have a mastectomy will die from complications, mostly infection, within one month following surgery — 1 in 400!!  And that’s not counting the women that pass away after 30 days.

This shocked me. The paper went on to say, statistically speaking, this was “insignificant.” (Gee, 1 in 400 sounds significant to me…)

Fast forward to 2009, when the breast cancer (BC) screening recommendations were changed by the relatively unbiased U.S. Preventative Services Task Force after reading what the Nordic Cochrane Centre had to say. A real brouhaha erupted following USPSTF’s change of heart, because they said women should now start screening at age 50 and only get mammograms every other year. The problem was that women didn’t realize at the time (and many still do not — I didn’t until recently) why the recommendations were changed to every other year in the first place (mostly over-diagnosis issue).

Meanwhile, the radiology societies stood their ground and still say to this day that women should get screened annually starting at age 40 — while also hinting around the edges that it really should be lowered to 35.

When I interviewed the Am. Cancer Society in 2016 for my film “bOObs”, Dr. Otis Brawley said the ACS recommended this as a compromise: “…women age 40 to 44 who want [mammography] should get it, but we recommend that all women start getting it at age 45. And then we recommend it annually from 45 to 54, and women should get it every 1 to 2 years 55 onward.”

Then basically most agree that screening is no longer necessary after about age 75 — except the radiation associations that think it should go on indefinitely (cue eyeball roll emoji). The reason they recommend a halt on screening is, in theory, older women will die of something else instead of the cancer, as BCs at that age are mostly slow-growing tumors due to decreased estrogen levels.

Following this debate over in the EU, the Swiss just threw up their hands and said they were going to try and phase out mammography entirely following the release of the Cochrane mega-analysis. But so far mammography hasn’t been phased out completely, according to a Swiss radiologist friend of mine, as the radiologists are still pushing mammograms to their patients.

So what is “a better test” that might take the place of mammography in the future? Tune in to upcoming blogs to find out.

Blog at you soon, thanks for reading and helping to spread the word! (Please see the “share” links below).

Stay healthy,

Megan

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

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