For decades, women across the United States have received a constant barrage of public-health messages about the importance of screening mammography. Faces of young women peer out from advertisements, delivering a concise message that has become an axiom of public health: Mammography saves lives.
Using mammography to diagnose a suspicious lump or a breast change isn’t controversial. However, the same can’t be said for screening mammography—the procedure of capturing images of breast tissue of healthy women who have no cancer symptoms—to detect potential cancerous masses. The procedure is both a right, because of insurance coverage that’s mandated by the government, and a rite of passage for women. According to Centers for Disease Control and Prevention (CDC) data from 2010, which is the most recent year for which information is available, at least 67 percent of U.S. women who are 40 or older (49.7 million women, according to National Center for Health Statistics), said they had a mammogram in the past 2 years. However, when it comes to the real goal of the campaign—saving lives, not just convincing women to get mammograms—the record is obscure. American Cancer Society (ACS) estimates that 295,240 new cases of breast cancer and 40,000 deaths from breast cancer will occur in 2014.
The mainstream message that women have heard for so long has been “Get a mammogram. It will save your life,” says Sahru Keiser of advocacy group Breast Cancer Action, which is critical of mammography. “It has been a one-sided message that doesn’t take into account the more current evidence about early detection. And it is a message that’s left no space for conversations about the potential harms.”
Not only are the benefits of mammography being oversold, critics say, but the risks largely also have been, until recently, ignored. Mammography itself poses little harm; the radiation levels are low enough to be of minimal concern, experts say. However, a mammography can result in overdiagnosis, which means the detection of cancer that might not prove to be life-threatening in a woman’s lifetime. This needlessly sets women on a treatment odyssey that poses medical, emotional and financial risks of its own, according to critics of screening mammography.
Financial Effects of Breast-Cancer Diagnosis
“It is challenging to embrace the concept that some breast cancers would be lying undetected, never destined to cause any problem, and that finding them is simply causing more harm than good,” says Cary Gross, who is a Yale University professor of medicine and epidemiology and whose research specializes in cancer. “But we know they do occur and that one result of an aggressive mammography campaign is that we are finding more of such cancers.”
These recent challenges to the established view of mammography as an inviolable precept of women’s health have caused emotional, and not always civil, battles in medical journals, the media and the blogosphere. U.S. Preventive Services Task Force (USPSTF), which is an independent panel of nonfederal experts in prevention and evidence-based medicine, announced in 2009 that it no longer recommended screening mammography for average-risk women (those who don’t have a genetic predisposition to cancer or a history of chest radiation) who are under 50. Further, the task force recommended that women who are 50–74 should get a mammography every 2 years. The response was widespread outrage; one USPSTF member even received a death threat. CDC agrees with the USPSTF recommendation and says that if you’re 40–49, you should talk with your doctor about when to start and how often to get a screening mammogram.
Still, the status quo for mammograms persists. ACS, American College of Radiology (ACR), American College of Obstetricians and Gynecologists, and American Medical Association all recommend annual mammograms for average-risk women who are 40 or older. At least for now, that is: ACS and USPSTF are in the process of updating their guidelines. Meanwhile, a flurry of recent studies and statistical analyses question whether women of any age should have a screening mammogram.