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Ronald Adler, MD |
The U.S. Preventive Services Task Force issued its final recommendations for mammograms, calling for biennial screening for women 50 to 74, and for women in their 40s to make “informed, individualized” decisions based on their “value, preferences and health history.” Ronald N. Adler, MD, associate professor of family medicine & community health, has lectured widely on the topic of overdiagnosis and supports the group’s recommendations.
“I think that for women who choose screening, the task force’s emphasis on every two years is appropriate, and I fully endorse the concept of women making decisions based on their own values and preferences,” Dr. Adler said.
The task force’s final recommendations for women by age are:
- 40-49: Informed, individualized decision making based on a woman’s values, preferences and health history;
- 50-74: Mammography every two years; and
- 75 and older: More research is needed.
Task force members did not make recommendations regarding screening in women with dense breasts or the effectiveness of 3D mammography, saying that evidence to determine the balance of benefit and harm on the issues was insufficient.
While the task force noted that screening mammography is effective in reducing deaths from breast cancer for women in their 40s, the likelihood of benefit is less than for older women and the potential harms proportionally greater.
Adler added that the recommended approach “preserves nearly all of the benefits of screening while reducing the harms associated with screening.”
“These include false positives, which are experienced by 60 percent of women who get regular mammograms, and the overdiagnosis of indolent cancers, which would never cause any symptoms or harm,” he said. “The frequency of this is still being debated, but estimates range from one in five to one in three mammographically detected breast cancers.”
Overall, mammography screening has been less effective than previously thought, in part because breast cancer treatment has improved, meaning that early detection is less important to achieving excellent outcomes, he said.
“This is the primary reason we’ve seen reductions in breast cancer mortality,” Adler said.
Regarding the recent announcement by the American Cancer Society to also amend its breast cancer screening guidelines, Adler said that there is now less conflict than ever before. In October, the American Cancer Society recommended postponing a healthy woman’s first mammogram until age 45 and continuing the screening annually until age 54 and then every other year as long as the woman remains in good health.
