by Lisa Simpson and Shannon Brownlee
Health Affairs Blog
May 15, 2015
Once again, the United States Preventive Services Task Force’s latest draft report on the potential benefits and harms of mammography screening was met by outcries from radiologists and others that thousands of women would die if the recommendations were followed. The Task Force concluded that women between the ages of 50 and 74 should get mammograms every two years. But for women under 50, the chances that a mammogram will help her rather than harm her are very small. For younger women, the decision to get a mammogram should be made on a case-by-case basis.
This is reasonable advice, but you wouldn’t know it from comments on Twitter and in some media outlets. In 2009, when the Task Force last issued recommendations on mammograms, everybody from breast cancer advocacy groups to members of Congress accused the panel of “killing women.” Radiologists, some of whom have a vested financial interest in mammography, claimed the panel used outdated evidence. One newspaper columnist suggested that Congress should “take pity on the Task Force and send it to the Death Panel for a humane end.” The reaction this time around has been only a little less negative.
Since then, the number of studies of mammography has grown, and if anything, the evidence is even stronger: we are consistently over-diagnosing and over-treating breast cancer — and younger women are paying the highest price. Women under age 50 who get regular mammograms have a more than 50 percent chance of a false positive after 10 years. Every positive finding on a mammogram requires further testing, often a needle biopsy, which isn’t pleasant. Studies have found that even when it turns out to be a false alarm, women suffer for years from the worry that they really do have cancer.
More worrisome than false positives however, is that research now suggests that between one in five and one in three breast cancers detected by mammograms did not need to be treated, or could have been treated successfully at a later time in the woman’s life. Unfortunately, doctors often don’t know how to tell the difference