Detecting cancer earlier: Doctors celebrate, discuss change in mammogram recommendations

A new recommendation for mammograms could speed up the timeline for breast cancer screening. It also might improve the chance of saving lives, according to local medical experts.

The U.S. Preventive Services Task Force, an independent volunteer panel of medical experts, changed its previous policy last week to advocate for women to get mammograms beginning at age 40 instead of 50 in a draft recommendation.

Mammograms, a type of breast cancer screening in which X-ray images are taken of breast tissue, already were recommended starting at 40 by some other professional organizations, including the American Cancer Society and American College of Radiology.

The move to update the task force’s advice brings all the different recommendations into alignment, increasing clarity of messaging, said AHN radiologist and breast imaging specialist Dr. Matt Miller.

“The USPSTF changed their recommendations to fall more in line with what other organizations are saying. That’s huge, because that’s a 10-year gap,” Miller said. “If women and clinicians were listening to them before, that’s 10 years’ worth of patients that we are now going to be screening with mammograms. We are going to be detecting more cancers with these patients, and we’re going to be saving their lives.”

Previously, Miller said, mammography recommendations could be “confusing.” Some patients would advocate for 40 as the age to start while others advocated for 50.

“It was up to the primary care physician what side of the fence they were on,” Miller said. “Most recommended 40, but there were some holdouts who said that the USPSTF said 50, we’re going to start at 50.”

Highmark insurance covers mammograms for average risk women starting at 40, and earlier for high-risk women, he said. If there are any insurance companies that do not cover mammograms starting at 40, this recommendation should move the needle.

A mixed victory

Not all physicians expect the recommendation change will make a big impact. Some have already been recommending their patients get mammograms at 40, following other organizations’ recommendations.

“It won’t change my practice, because I follow the American College of Radiology and the American Society of Breast Surgery recommendations,” said Dr. Sharon Goldstein, director of the breast center at Excela Health. “I believe people should continue getting yearly mammograms, starting at age 40, if they’re at average risk.”

The frequency of mammograms is a point of contention between some physicians and the USPSTF. The new recommendation still suggests mammograms should be done every other year, but some other organizations recommend them annually.

“It was a big step, but an incomplete step, because they didn’t go all the way and say they should get annual mammograms at 40,” said Miller. “The dataset they used explicitly states that starting at age 40 and doing annual mammograms saves the most lives, but they stopped short — they recommended getting it every other year.”

Dr. Denice Leonard, an OB-GYN specialist at Butler Health System, said she also doesn’t see much change coming to her practice with the new recommendation.

“For me and my patients, I don’t think that is going to make any difference,” she said. “I order mammograms for average risk women at 40. There is some recommendation to do it every other year, but a lot of women feel more comfortable getting that screening mammogram yearly.”

Determining risk

Goldstein noted a less than 20% lifetime risk of developing breast cancer puts a patient in the “average risk” category, which is the category covered by the new recommendation. If a patient is “high risk,” or at a greater than 20% lifetime risk of developing breast cancer, further tests or monitoring can follow.

“We use various calculations across the country, but we calculate a risk percentage for every patient who comes to Excela’s imaging center, and that is based on family history and personal history of prior surgery, biopsies and other patient factors,” she said. “We approach this with a holistic approach, meaning we look at the whole patient.”

Patients can get a sense of their risk ahead of time by using an online tool called the Tyrer-Cuzick risk calculator, she noted.

“I’m a big believer that knowledge is power,” she said. “It looks at things like breast density, medical history that’s breast related, age of first period, whether someone is through menopause, whether someone is on hormone replacement therapy, whether they have had children, whether they have nursed. It’s like a whole breast history. There’s a whole section for family history.”

Keeping up with mammograms

The pandemic saw some women falling behind in their mammograms, though Western Pennsylvania already has caught up to pre-pandemic volumes, unlike the rest of the country, Miller noted.

“I will run into people sometimes who haven’t had one since 2019,” he said “I will sometimes do a baseline screening mammogram on someone in their 60s, who decided to come in because they saw a friend get breast cancer, and thought, ‘I’m going to get my mammogram, even though I’ve never done it before.’”

Fear sometimes keeps patients away, as some avoid getting their mammogram done because of concerns that the process is uncomfortable.

“Some women are concerned about the radiation exposure, and some are concerned that it is painful, or they had one maybe years ago that was painful, and they throw their arms up and say, ‘I’m not doing it again,’” said Leonard.

Mammogram technology has advanced in recent years, Miller said.

“The preconceived notion about mammograms is they hurt and are uncomfortable because we have to do compression. I’m a male, so I’ve never had a mammogram, but talking to my patients, mammograms now are not nearly as uncomfortable as they were 15 or 20 years ago,” he said. “The image quality we are able to obtain, it’s just like your cellphone, your camera on your cellphone is better than professional cameras 10 years ago.”

Spreading awareness about the importance of mammograms still is important, even though their use is widespread, Miller said.

“We do a pretty good job at getting the info out there, but we’re not going to rest on our laurels. There’s always a need for advocacy and outreach,” he said. “We as a health care community are not shy about making sure women know that annual screening mammography at age 40 is the ticket—that’s what saves the most lives.”