What is the goal of the "40 not 50" campaign?
The goal of the campaign is to educate women about the benefits of screening mammography beginning at age 40. Women are encouraged to take charge of their own health.
Who is recommending that women start screening mammograms at age 50?
The United States Preventive Services Task Force (USPSTF) has recommended that women wait until age 50 to start mammograms and repeat mammograms every two years instead of every year. The USPSTF is a government-appointed task force made up of primary-care physicians and non-physicians. Their mission is to publish evidence-based guideline for medical care. However, none of the doctors on the task force specialize in breast cancer. We believe this has impaired the committee’s judgment. They’ve made recommendations without the input of expert physicians.
If mammograms are so beneficial, why has the USPSTF asked women to wait until age 50 before getting them?
Mammograms are costly and we believe the USPSTF has asked women to wait in order to contain medical costs. Although we are also concerned with the spiraling cost of medical care, asking women to delay cancer screenings is not the solution. Cost reduction is often at the expense of women's health.
Do any organizations recommend starting mammograms at age 40?
Several major health organizations still recommend women begin mammograms at 40. They include:
- The National Comprehensive Cancer Network (NCCN). An alliance of 27 of the world's leading cancer centers whose focus is creating better and more effective cancer treatments.
- The Mayo Clinic. The world's largest non-profit medical group. Their goal is to ensure patients receive the best health care possible through state-of-the-art clinical practices and medical research.
- American College of Radiology. An association of doctors and technicians specializing in radiology and medical imaging. Their members include diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians, and medical physicists.
- Society of Breast Imaging. A group of radiologists, medical physicists, and technicians dedicated to combating breast cancer by improving techniques for early detection. They are strongly opposed to the USPSTF's mammogram guidelines.
- American Congress of Obstetricians and Gynecologists. A professional membership organization dedicated to the improvement of women's health.
What evidence is there that starting yearly mammogram screenings at age 40 saves lives?
The connection between mammogram screenings and survival rates has been studied multiple times, and almost every study has demonstrated that early mammogram screenings saves lives. Detecting cancer in its early stages enables doctors to treat it more effectively. Women who start regular cancer screenings at age 40 are 20-60 percent more likely to survive than women who delay screenings until a later age. Additionally, new breakthroughs such as MRIs, ultrasounds, and 3D mammograms may be able to reduce breast cancer mortality by more than 50-70 percent.
If the evidence is so overwhelming, why does the USPSTF only recommend mammograms for women over 50? Response by Dr. John West.
The USPSTF has not provided a clear explanation as to why they've made their recommendation to start screening at age 50, but the evidence suggests they may have been swayed by a Canadian cancer study that claimed mammograms were not effective in women 40-49. The study examined a group of breast cancer patients over a span of 25 years and concluded that mammograms did not increase a woman's chance of survival.
This Canadian study was seriously flawed. It was performed using outdated equipment and its doctors and technicians were poorly trained. Its conclusions are also highly suspect. The second major flaw of the study is a nurse examined all participants before they were assigned to the group that received a mammogram or to the group that did not receive a mammogram. As it turned out, more women with suspicious breast lumps were assigned to the group receiving a mammogram.
There was no benefit from mammography screening when more women who already had advanced breast cancer were diverted to the group was to receive a mammogram. In fact, the study reports that 19 of 24 patients with advanced breast cancer were directed to the group that received a mammogram. This diversion of patients with obvious breast cancer into the group receiving a mammogram in part explains their astonishing conclusion that 22% of breast cancers would “disappear” without treatment. This is a startling conclusion considering there has never been a single documented case of a breast cancer disappearing without standard treatment.
It was this series of flaws in study design that lead the inaccurate conclusion that screening mammography in the 40-50 age group caused more harm than good, when in fact a more recent study from Canada demonstrates a 40% reduction in breast cancer mortality for women who undergo yearly screening starting at age 40.
If they had examined the study with breast cancer experts, they may have discovered the same flaws we did. The reason the researchers thought mammograms didn't affect the death rate was because all the patients were screened by nurses before the study started. Women with obvious cancer symptoms were funneled into the group that received mammograms, and the women without cancer symptoms were sent into the group that didn't. This altered the study's outcome and disguised the role mammograms play in saving lives.
- Dr. John West, Breast Surgeon
Are there any other reasons the USPSTF used to justify their new guidelines? Response by Dr. John West.
Besides the Canadian study, the task force also claimed that breast cancer is over diagnosed and that many of the anomalies uncovered by mammograms are benign and won't harm patients if left untreated. While this is true for elderly women diagnosed with low-grade, non-invasive cancers, it's not true for women in their 40's. For younger women, low-grade, non-invasive cancers will become invasive and life-threatening if left untreated.
The task force was also worried about the risks of false positive biopsies. False positive biopsies occur when doctors detect a spot on a mammogram and order a biopsy, only to discover that the spot isn't cancerous when the biopsy's completed. The task force noted that young women are more likely to have false positive biopsies and that false positive biopsies cause a great deal of stress and anxiety in women.
Breast biopsies can cause a great deal of distress, but so does a delayed breast cancer diagnosis. True, younger women are more likely to have a false positive than older women, but they're also more likely to develop fast-acting and aggressive cancers than older women. The risk of a false positive has to be weighed against the risk of delayed treatment.
- Dr. John West, Breast Surgeon
Should every woman start screening at age 40?
The decision to start mammogram screenings is a personal one and should be made by women based on their family history and their risk factors, such as a strong family history of breast and ovarian cancer or undergoing chest wall radiation at a young age.
For most women, the general rule is you should start screening ten years earlier than the age your first-degree relative was when they were diagnosed with breast cancer. For example, if your mother or sister was diagnosed when they were 45 you should begin discussions with your physician at age 35.
What's my risk of developing breast cancer?
Every woman is at risk of breast cancer, and the risk increases as they get older. By age 50, roughly 1 in 43 women will develop breast cancer. By age 60, it's 1 in 29. By age 80, it's 1 in 8.
Your degree of risk depends on several factors, but the biggest is your family history. Women with a family history of breast cancer or ovarian cancer should talk to their doctor about risk assessment and genetic testing in order to determine if more aggressive efforts are required to detect breast cancer before it becomes life-threatening.
Does breast density influence my risk of developing cancer?
Women with dense breasts are more at risk for cancer. Dense breast tissue also makes it more difficult to detect breast cancer using mammography. We recommend that women with dense breasts consider additional imaging techniques such as whole breast ultrasound or a breast MRI, especially if they have a family history of breast cancer.
How do I know if I have dense breasts?
In most states doctors are required to report your density status on the mammogram report. Unfortunately, most doctors don't have time to discuss density status and alternative screening options with their patients. It's important for you to be proactive when you meet your doctor, and ask about your breast density and alternative screening options.
What can I do to lower my cancer risk?
The easiest way to reduce your risk of developing breast cancer is a balanced diet and regular exercise. Breast cancer is more common in women who are obese and sedentary. Recent studies have also shown that consuming three or more alcoholic drinks per week will increase your risk. Smoking also increases a woman's risk. There are controllable and uncontrollable risk factors associated with breast cancer. We recommnend talking to your physician about your risk.
Have there been any new breakthroughs in early detection of breast cancer?
The science of early detection is still advancing and researchers are continually making progress. Recent developments include:
- 3D Mammograms. This new technology provides a 3D image of the breasts. It's not only more effective at detecting small breast cancers than standard 2D imaging, but it also decreases the need to take additional images of the breast. Though 3D mammograms are effective for all women, they are especially beneficial for women with dense breasts.
- Whole Breast Screening Ultrasound. This technique can detect small cancers missed in screening mammograms. It's safe and relatively inexpensive. Like 3D mammograms, it's especially beneficial for women with dense breasts.
- Breast MRI. Breast MRIs are the most accurate tool available for detecting small cancers, but because of it's cost, it's generally restricted to high-risk patients.
Should I consider genetic testing?
Until recently, genetic testing was limited to women with very strong family histories of breast cancer and ovarian cancer. The price of genetic testing has decreased dramatially within the last few years.
What can I do to support 40 not 50?
Sign our petition to have the USPSTF alter its guidelines. Tell your friends about the campaign. Share it on Facebook, twitter, and social media. Send us your ideas, comments, and suggestions about how we can spread our message and educate more women on this important issue.