Henry Ford Continues to Recommend Mammograms at 40

January 12, 2016

DETROIT - The final breast cancer screening guidelines released today by the U.S. Preventive Services Task Force (USPSTF) will increase the number of younger women and African American women diagnosed with advance stages of breast cancer, according to experts at Henry Ford Health System.

Henry Ford Breast Cancer Program physicians believe that breast cancer screening, as a means of early cancer detection, is vital to successful treatment outcomes and will continue recommending that patients begin annual mammography screening at age 40.

As a major provider of health care to the diverse metropolitan Detroit population, the Henry Ford team states that it is detrimental to women’s health, especially African American women, to wait until age 50 to get a mammogram.

“African American women are more likely to be diagnosed with breast cancer at younger ages, and are more likely to be diagnosed with aggressive forms of the disease such as triple negative breast cancer,” says Lisa A. Newman, M.D., MPH, director of Henry Ford’s the Breast Cancer Program.

“If USPSTF recommendations are widely adopted, we will likely see expansion of the breast cancer mortality gap that already exists between African American and White American women.”

While the Task Force found mammography an effective tool to reduce the risk of death for women ages 40-74, it recommends that regular, biennial mammograms not begin until age 50.

Starting regular mammograms before 50, the Task Force says, should be a personal decision made in partnership with a physician.

Radiologist Patricia Miller, M.D., FACR, who heads breast imaging services at Henry Ford, fears that without yearly screening for women ages 40 and above, cancers will not be found until they are large and difficult to treat.

She adds: “About 17 percent of cancers diagnosed at Henry Ford are in women under 50, and among all cancers diagnosed, 75 percent of women have no risk factor other than being female.”

The Task Force – an independent, volunteer panel of experts in evidence-based medicine – examined the evidence on women who were not known to be at increased risk of breast cancer.

The group released a draft of their guideline update several months ago. This final version closely mirrors their November 2009 guideline, which prompted widespread controversy and led to the October 2010 Presidential Proclamation that the Affordable Care Act would continue to cover annual screening mammography costs beginning at age 40.

The Task Force’s final guideline statement is made up of several recommendations, addressing different age groups and screening methods, including:

  • Screening mammography is effective in reducing deaths due to breast cancer among women ages 40 to 74.
  • Women ages 50 to 74 be screened regularly.
  • Women in their 40s make an individual decision in partnership with their doctors.

Additionally, the American Cancer Society (ACS) released its revised guidelines in October 2015, demonstrating a slight shift from its previous stance that average risk women must undergo an annual mammogram and clinical breast exam starting at age 40.

The new ACS guidelines state that although women should have annual mammograms available beginning at age 40, they may defer initiation of screening until they reach age 45. The ACS also states that while yearly mammograms should be an option, switching to biennial screening at 55 is a reasonable strategy. The ACS recommends continued screening for as long as a woman is in good health and has a life expectancy of at least 10 years.

The Henry Ford breast cancer team also stresses that wide variation in recommendations for timing and frequency of mammography screening leads to unnecessary confusion and erodes public confidence in the effectiveness of cancer screening.

Both USPSTF and ACS support mammography’s role in saving lives, and say that women should have the opportunity to get annually screened beginning at age 40, if that’s what they choose to do.

While overdiagnosis, false positives and the associated anxiety are issues to be considered, many groups including the American College of Radiology, Society of Breast Imaging and even the ACS agree that overdiagnosis claims are inflated due to key methodological flaws in many studies.

“Early detection is our best weapon against breast cancer mortality and greatly outweighs the risk of false-positive results,” says Dr. Newman.

Overall, Dr. Newman encourages all women to know their family medical history, be aware of any changes in their breasts, and talk with their physician about any concerns.

Krista Hopson Boyer, kboyer1@hfhs.org