In December 2009, the United States Preventive Services Task Force (USPSTF) released updated guidelines for when and how often women should have screening mammograms. Prior to the recent announcement, the standard was every 1-2 years starting at age 40 and every year starting at age 50. The new guidelines were shocking and controversial. They recommended against routine screening mammograms from ages 40 to 49 and recommended a screening mammogram every 2 years after age 50, a significant departure from the previous standard.
Their reasons were lengthy but can be boiled down to a few issues:
- Since breast cancer is less common from ages 40 to 49, more mammograms would be required to find a cancer.
- The cancer will be found eventually even if the mammograms are done less often, and some data suggested that early detection and treatment of breast cancer did not seem to prolong survival.
- The extra mammograms would result in more women being exposed to radiation, more women dealing with the stress of an abnormal mammogram, and more unnecessary breast biopsies.
- Their own data showed that it would take 1,900 routine mammograms in the 40-49 age group to find one cancer, compared to 1,300 mammograms in the 50-59 age group, and so on.
Not surprisingly, not only their guidelines, but their explanation of the reasons for the guideline changes, generated a great deal of controversy. These guidelines failed the common sense test. Women ages 40-49 fear having cancer far more than they fear a breast biopsy procedure. Cost was never addressed by the USPSTF but the public’s reaction was immediate. This was a blatant cost-saving policy and would result in women being diagnosed with cancer at an advanced stage.
It takes 600 more mammograms to find one cancer in the 40-49 age group. This is maybe $120,000 of cost per cancer detected. Most experts consider this a bargain. But not doing these mammograms at all would save the government and major insurance plans millions of dollars.
Ultimately every major medical organization in the U.S. dealing with cancer and women’s health denounced these new guidelines, and so did the White House. Our current recommendation remains the same: a baseline mammogram at age 38, and then annually at age 40. Early detection of breast cancer saves lives. Mammograms are safe and extremely cost-effective, and we support their continued availability.