In the past few months, so many conflicting statements, recommendations and guidelines have come out that it is no wonder women are more confused than ever as to when to get a mammogram. To put it simply, The American Congress of Obstetricians and Gynecologists, American College of Radiology, The Society for Breast Imaging, and the radiologists who practice at 30-year old Solis Mammography all agree that a woman should begin regular, annual mammograms at age 40. Experts agree that early detection is the best offense in the fight against breast cancer, regardless of confusing guidance from some organizations, made without critical breast imaging physicians on their panels. As of today, insurance companies still cover annual screenings starting at age 40, but this could be in jeopardy in the future if people are not educated about the potential harms of delayed screening.
In 2015 alone, 50,000 (22 percent) of the 230,000 women diagnosed with breast cancer in the United States were under the age of 50. We are astounded that any rational person would recommend women ignore screening and therefore, any potential cancer, allowing it to progress dangerously for any protracted period of time.
Medical research shows that annual mammograms for women between 40 and 64 years old are key, and that the earlier a woman and her physician discover a breast health issue, the easier her treatment options are for a better outcome. Women diagnosed with stage 0 or 1 breast cancer have a 100 percent 5-year survival rate, according to the American Cancer Society (ACS). The ACS also states that the decrease in breast cancer-related deaths over the past two decades is almost entirely attributed to mammography detection.
“Mammography is the single most effective method of early detection since it can often identify cancer several years before physical symptoms develop. It is the position of the American Cancer Society that the balance of benefits to possible harms strongly supports the value of regular breast cancer screening in women for whom it is recommended,” stated the ACS in its “2015-2016 Breast Cancer Facts & Figures” report.
Confusion created by new guidelines
In October 2015, the ACS issued new mammogram guidelines advising women to wait until the age of 45 to have their first mammogram. The ACS pointed to potential problems such as false-positive test results and over-diagnosis (which means there was thought to maybe be a cancer, but upon second evaluation, there wasn’t) as reasons for the change. Similarly, the U.S. Preventive Services Task Force (USPSTF) issued mammogram guidelines recommending women delay their first screenings until 50. These conflicting announcements have clouded the issue on what age a woman should begin annual screenings. And, more importantly, these guidelines delay the opportunity for early detection by a potentially life-altering 5 to 10 years. In addition, breast cancers in younger women have shown to be a lot more aggressive, therefore making early screening that much more important.
The new and differing ACS and USPSTF guidelines increases the number of women who will be at risk of compromising their health. Both groups state the new guidelines don’t apply to women with first-degree family histories (i.e. mother, sister, or daughter), but research proves that family history only accounts for 13 percent of all breast cancer diagnoses.
One has to wonder if the new guidelines were set forth to aid insurance companies in limiting coverage. As of this publishing, insurance companies still pay 100 percent of a woman’s annual 2D mammogram annually commencing at 40 years of age. Some insurance carriers have already blocked 3D mammogram coverage, even though research shows that 3D mammography is the very best screening available. (According to the American Journal of Roentgenology, 2013, 3D mammography has proven a 37 percent reduction in unnecessary patient callbacks and a corresponding 40 percent increase in detection of breast cancers.) With the new guidelines, insurance companies have ammunition for mammography coverage limitations. For this reason, Solis Mammography participated in a lobbying effort that successfully resulted in congressional legislation, creating a two-year moratorium on denying mammography coverage for women in their 40s.
Clarification: Early detection has clear advantages
The first step to gaining clarity for women is to share their individual and unique concerns about the confusing guidelines with their primary care physicians. Ultimately, it is the patient and her doctor who can and should make the right decision for her – not the ACS, not USPSTF, and certainly not insurance companies.
When a woman participates in regular, annual mammography and a cancer is detected, it is normally the size of a pea. For women who forgo mammography and self-breast exams, the cancer is normally the size of a walnut when first detected (as shown in the Confusion vs. Clarity infographic.) While the vast majority—over 90 percent—of mammography patients have clean mammograms, those whose mammograms do find an issue, usually find it early, at the average size of a pea. This smaller size gives a woman tremendous advantage in terms of long-term survival, and easier and better treatment options.
So many people think of the “Early Detection Saves Lives” slogan, and it’s true that it does.
However, with advances in medicine, the mortality rate from breast cancer is going down – and, therefore, many question if early detection is as important as it used to be. We at Solis Mammography believe absolutely that it is – because while saving your life is job No. 1, a woman’s quality of life runs a close second. Simply put, when you find it earlier, your choices are better, you have more options to treat versus late stage, and the treatment is more likely to be less aggressive, less expensive, and with a better outcome. This is what our business is all about, and certainly is worth the 30 minute investment it takes, once a year, to get checked!
Solis Mammography’s chief medical director, Dr. Stephen Rose, says, “The frustrating thing for me about the new recommendations is that it isn’t as if they offer any alternative to mammography. Mammography is simply put, the closest thing we have to a cure. To avoid screening entirely for 5 to 10 critical years is just reckless.”
As for the ACS and USPSTF’s concerns about “false positives,” these are simply callbacks for more tests to ensure accuracy. The national average for recall rates is between 10 to 12 percent. At Solis Mammography, it’s even lower — 8 percent, with no difference in the detection of cancers. And thanks to our investment in 3D mammography, added to our team of breast-dedicated radiologists (who spend more than 90 percent of their time reading mammograms), this rate continues to decline.
The future is certain to bring new and conflicting recommendations regarding mammography screening. Women need to remember that the earlier they find breast cancer, the greater their options for treatment. Early detection has long-term benefits for women — including improved quality of life — such as the potential to avoid mastectomy, chemotherapy, or radiation therapy. In short, women should be empowered with the knowledge to make the best choices for them based on their unique health history and primary care physician’s recommendations. Peace of mind, overall wellness, and long life all come from early detection. Consult with your doctor today and if you’re ready for a mammogram, know that you are still covered for early detection and annual preventative breast health, starting at age 40.
James Polfreman is CEO of Solis Mammography. A 30-year leader in women’s breast health, Solis strongly believes that early detection ensures better outcomes for patients. www.solismammo.com
