WHEN SHOULD WOMEN START MAMMOGRAPHIC SCREENING

By: Kamilia Kozlowski, MD

It is amazing to me when I am speaking to women that they are surprised and unaware that 80 % of breast cancers that are diagnosed every year are in women that do NOT have a family history of breast cancer. I think the main reason is that family history is stressed so much in the media. Our statistics at KCBC support this fact as well.
So at what age should the average risk women start screening for breast cancer? There has been so much confusion with the recommendations of the U.S. Preventative Task Force under Obama Care stating that instead of starting at age 40, start at 50 and stop screening at 74. I was even surprised when the American Cancer Society changed their guidelines to recommend starting at 45 doing yearly until 54 and then every other year. Unfortunately, I am seeing physicians not recommending screening for their older patients. We diagnose women in their nineties with breast cancer.
Here is a summary of a study published by the American Journal of Roentgenology In May 2017.

Starting breast cancer screening at 50 means that up to 20% of breast cancers could be missed – offering more proof that women between the ages of 40 and 49 should be screened regularly.
Screening mammography guidelines published by the U.S. Preventive Services Task Force (USPSTF) recommend that women begin biennial screening at age 50, While the American Cancer Society (ACS) recommends annual screening starting at age 45 through age 55, with biennial screening thereafter. Both organizations do state that the decision of when to start screening is up to women and their healthcare providers to discuss.
But these guidelines are dangerous, according to a team led by Dr. Jenifer Pitman of Weill Cornell Medical College in New Your City. Pitman and colleagues conducted a study to determine how many cancers might be missed if women between the ages of 40 and 49 were not screened.
“Women in their 40s would probably be interested in knowing what might happen if they were to choose to follow one recommendation over another,” the authors wrote. We found “that during the study period (2014-2016) women in their 40s overall had 18.8% of screen-detected breast cancers – more than 60% of which were invasive… Increasing the risk of a later stage at diagnosis and thus a poorer prognosis.”

I can support whole heartedly and encourage all women from the age of 40 to have a yearly mammogram. This table is food for thought when reviewing the average risk women in the U.S. that is diagnosed with breast cancer.

Incidence of Breast Cancer
A Woman with Average Risk
(No Family History of Breast Cancer)

1 out of 64 – Forty Year Olds
1 out of 50 – Fifty Year Olds
1 out of 25 – Sixty Year Olds
1 out of 12 – Seventy Year Olds
1 out of 8 – Eighty Year Olds

Average Doubling Time of a Breast Cancer:
1 Year

80 % of women diagnosed every year have NO
Family History of Breast Cancer.
The proper time interval for screening of All
Women over 40:
1 Year