40 not 50
- Government appointed task force (USPSTF) recommends start screening mammograms at age 50.
- Starting mammograms at age 40 saves lives.
- The impact is that young women may die needlessly from metastatic breast cancer
- Fight back: Join our campaign; sign the petition; send us your comments
A Message from Dr. John West
A government appointed task force is now recommending that women start mammographic screening at age 50, do it every other year and stop at age 74 (ref. 1A). These guidelines are based on flawed science (ref. 2 -4), they were written by a committee that did not include a single breast-dedicated physician. It was the lack of expertise among committee members that allowed them to be influenced by a study that was so poorly designed that consultants from the USA and Sweden resigned and are now publicly critical of conclusions of the study. AI am convinced that the committee’s primary goal in making these recommendations was cost-containment. The issue of how these guidelines would adversely impact women’s health was essentially ignored.
The Problem: We are already seeing the ill-effect effects of the committee’s recommendations. Women are confused about conflicting guidelines, and many are content to delay screening until age 50. Doctors don’t have time to discuss screening options, and some have now stopped ordering mammograms for women in their 40s.
However, the most important effect of the new guidelines is that it gives insurance companies an excuse not to pay (ref. 1b) Already, our patients are discovering that some insurance companies are denying payment for mammograms. Unless something is done to reverse this trend, insurance companies will undoubtedly expand their efforts to deny payment for screening mammograms.
The impact on women’s health will not be immediately apparent, but in the near future it will become clear the new guidelines are leading to diagnostic delays. More women will be diagnosed with advanced cancer requiring more aggressive treatments (chemotherapy, surgery & radiation). Breast cancer mortality rates will rise. Young women will die needlessly and children will grow up without their mothers.
The irony is that this is taking place at a time when incredible progress is being made in the early detection of breast cancer (ref. 5). We now have new technology (3-D mammograms, screening breast ultrasound and breast MRI) that gives us the potential to reduce breast cancer mortality by more than 50% (ref. 6). Thus, just when we are making great strides in breast cancer care, we on the verge of taking a major step backward.
The key to reducing breast cancer mortality is to start yearly mammographic screening at age 40 and younger if at high-risk (average risk ref. 7: high-risk ref. 8). Breast cancer is a disease of younger women (ref. 9). More years of life are lost for women diagnosed with breast cancer in their 40s than all the years of life lost for women 50 and over. Additionally, the majority of lethal breast cancers occur in women who were diagnosed before the age of 50.
It is time to fight back. We are starting a grassroots campaign to protest against these new guidelines, and to educate women about the value of early detection. The campaign is called 40 not 50 and we need your help. What you can do:
Don’t allow a government-sponsored agency reverse the progress in early detection that has been made in the past decade. Don’t let policies be established that will lead to the loss of life of young women because of a delay in diagnosis of breast cancer.
Recommendation by government agency to start screening at age 50:
A. U.S. Preventive Services Task Force. Draft Recommendation Statement: Breast Cancer: Screening. Rockville, MD: U.S. Preventive Services Task Force; 2015.
B. Explanation of how new legislation would give insurance companies the right to deny payment for mammograms for women under 50. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening
Task force Guidelines are based on Cost-containment:
- Kopans, D., B. "Criticism of breast-cancer screenings is more about rationing than rationality". Wall Street Journal. May 2014. http://www.wsj.com/articles/SB10001424052702304547704579564440536353948.
The one study that concludes mammograms don't save lives: (only "randomized" study that has come to this conclusion).."The first Canadian study:
- Miller A.B., Wall C., Baines C. et. al. "Twenty Five Year
Follow-up for Breast Cancer Incidence and Mortality of the Canadian National
Breast Screening Study: Randomized Screening Trial," British Medical J 348
(February 2014): g366.
Critiques of the First Canadian study:
- Kopans D.B. "The Most Recent Breast Cancer Screening Controversy About Whether Mammographic Screening Benefits Women at Any Age: Nonsense and Nonscience," AJR 180 (January 2003): 21-26.
- Boyd N.F., Jung R.A., Yaffe A.J. et. al. "A critical Appraisal of the Canadian National Breast Cancer Study," Radiology 189 (January 1994): 661-663.
- Boyd N.F. "The Review of Randomization in the Canadian National Breast Screening Study: Is the Debate Over?" Canadian Medical Association 156 (1977): 207-209.
- Weiss, M. "Garbage In, Garbage Out: A Flawed Study Cannot Measure the Value of Mammograms." Huffington Post April 2014. http://www.huffingtonpost.com/marisa-weiss-md/garbage-in-garbage-out-a-_b_4824005.html
- Heywang-Köbrunner S. H., SchreerI., Hacker A. et. al. "Conclusions for mammography screening after 25-year follow-up of the Canadian National Breast Cancer Screening Study (CNBSS)." Eur Radiol 26 (2016):342–350.
Studies proving the effectiveness of starting mammographic screening at age 40 (two key studies out a long list of studies):
- Tabár L., Vitak, B., Chen T.H. et. al. "Swedish Two-County Trial: Impact Mammographic Screening on Breast Cancer Mortality During 3 Decades," Radiology 260 (September 2011): 658-663.
- Coldman A., Phillips N., Wilson C. et. al. "Pan-Canadian Study of Mammography Screening and Mortality From Breast Cancer," Natl Cancer Inst 106 (July 2014):1-7.(Second Canadian Study)
New technology that can reduce breast cancer mortality:
- Schattner E. "Automated Ultrasound Can Improve Breast Cancer Detection In Women With Dense Breasts." Forbes/ Pharma& Healthcare. April 2015.
- Friedewald S. M., Rafferty E. A., Rose S.L. "Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography,"JAMA311(2014): 2499-2507.
- Kelly M.K., Dean J., Coumlada W.S. et. al. "Breast Cancer Detection Using Automated Whole Breast Ultrasound and Mammography in Radiographically Dense Breasts," EurRadiol 20 (March 2010): 734-742.
- Berg W. A.,Zhang Z.,Lehrer D, Jong R.A. "Detection of Breast Cancer With Addition of Annual Screening Ultrasound or a Single Screening MRI to Mammography in Women With Elevated Breast Cancer Risk"
Organization that advises starting screening mammography at age 40:
- The National Comprehensive Cancer Network®(NCCN®) is an alliance of 27 of the world's leading cancer centers, working together to improve quality and effectiveness of cancer care: https://www.nccn.org/about/news/newsinfo.aspx?NewsID=231
- Also see: National Comprehensive Cancer Network. "For Breast Cancer, When to Screen or Not to Screen? That is the Question Plaguing the Minds of U.S. Women—and Their Clinicians." April 2016. https://www.nccn.org/patients/foundation/newsdetail.aspx?NewsID=672
- Mayo clinic: http://www.mayoclinic.org/testsprocedures/mammogram/expert-answers/mammogram-guidelines/faq-20057759
- American College of Radiology(ACR). .. http://www.mammographysaveslives.org/Facts/Guidelines.aspx
Evidence that breast cancer is in large part a disease of young women:
- Webb M.L.,Cady B.,Michaelson J.S. et. al. "A Failure Analysis of Invasive Breast Cancer: Most Deaths From Disease Occur in Women Not Regularly Screened," Cancer 120 (Sept. 2014): 2839-2846.
- Bevers T. "Screening Mammography for Breast Cancer Saves Lives :MD Anderson recommends most women begin screening mammography at age 40. OncoLog May 2014. https://www2.mdanderson.org/depts/oncolog/articles/14/5-may/5-14-hc.html