For years most women have been told to begin annual mammograms at the age of 40. But recent changes in the guidelines have called into question how frequently, and at what age, women should be receiving these potentially lifesaving screening exams.
“These differing guidelines are very confusing to women,” says Emily Conant, MD, professor of Radiology and chief of Breast Imaging at the Hospital of the University of Pennsylvania. “This confusion could lead to fewer women getting screened or women having less access to screening.”
“Since the 1990s, mammography has reduced the rate of breast cancer deaths by about 30 percent,” adds Antje Greenfield, MD, clinical radiologist and associate clinical professor of Radiology at Penn Medicine. “It’s been proven in research studies to save lives and now 3D mammography is really taking things to the next level. We are seeing the breast tissue in greater detail and have increased detection rates of some cancers by as much as 40 percent.”
Conant attributes the controversy over mammogram recommendation guidelines to a variation in the review of mostly outdated data and concerns over the high false positive rate of conventional screening with 2D mammography.
“The data on the improved outcomes from screening with 3D mammography are evolving quickly and the recent, updated guidelines were made before much of this data was available.” explains Conant. “As the new data on 3D mammography gets out, we hope that policy makers and insurance companies will provide coverage for this ‘better mammogram.’
“At Penn, we are also doing a lot of research to create robust, reproducible systems of screening and reporting that can be personalized for each woman,” she adds. “This takes into consideration her breast cancer risk and personal preferences.”
Another factor influencing mammography recommendations is the issue of breast density. “Women with extremely dense breasts have an increased rate of developing breast cancer, about three to five times higher than those with low density or entirely fatty breast tissue, says Conant.”
“3D mammography has been the standard at Penn for the past five years,” explains Conant. “Although it is more costly, we are happy to screen all of our patients using this technology because it’s simply the right thing to do.”
Yet another issue surrounding the mammography screening debate is the routine use of supplemental testing, such as ultrasound and MRI for women with dense breasts and those who have a positive mammogram result.
“Ultrasound screening is still controversial, but could be helpful in conjunction with mammograms to distinguish between things like harmless benign cysts and early signs of cancer,” says Greenfield.
“Abnormal densities found on mammograms can be uncertain. Ultrasound allows us to provide further characterization of the finding .”
“We’re also working on another technique at Penn that we think will be even better than ultrasound,” Conant says. “We know that MRI with mammography shows more cancers than MRI or mammography alone and MRI has less false positives than ultrasound, but it’s expensive and not cost-effective for every woman. We’ve created a fast, or abbreviated, MRI that brings the price point close to that of an ultrasound with the improved accuracy of MRI.”
So how often and at what age should a woman receive a mammogram?
“The one thing everyone agrees on is that women should be screened annually for at least 10 years beginning at age 45,” says Greenfield. “Those under 45 and over 54 need to have a conversation with their healthcare professional about their individual risk factors to determine their personal screening schedule.”
“It’s a personal decision for every woman.” adds Conant. “While the incidence of breast cancer does increase with age, research suggests that premenopausal women who get cancer have faster-growing cancers because of their hormonal state. One size does not fit all when it comes to mammography screening and women should discuss their options with their healthcare provider.”