When to Get a Screening Mammogram
How often and when to start routine mammograms is a matter of debate.
Both Evans and Lichtenfeld say annual screenings, rather than biannual, are especially important for women in their 40s because cancer tends to grow faster and more aggressively in younger women.
The government task force found a benefit to screening every other year because it reduced the number of false-positive results. "We asked what the risk-benefit ratio between one-year and two-year intervals was and the trade-off seemed to be favorable," Petitti says.
But Lichtenfeld takes issue with the task force's analysis. It looked at the number of women that need to be screened in order to save a life but not the number of years of life saved, he says. "If you find breast cancer in a young woman and save her life, she has more years of life ahead of her. Had they used that analysis, the [task force] may have come to a different conclusion," he says.
The federal health reform law put mammograms on its list of preventive services, which mandate that insurance plans cover the test each year with no cost-sharing. The task force's 2002 recommendations, which state that women should begin mammography at age 40 on an annual basis, were used by the government in writing the law.
Medical experts express concern that at some point these new recommendations will be adopted, threatening women's ability to access and pay for annual breast cancer screening in their 40s. However, there is no indication that the government plans to stop requiring insurers to fully cover the cost of mammograms for women in this age group.
The Bottom Line
At this point, the task force's recommendations are in contrast with the majority of other major medical associations. Most of those groups recommend women begin getting routine screening mammograms at age 40 and do so every year.
In the end, Petitti says, the distance between the task force and everyone else isn't so wide. "There is more agreement than disagreement," she says. "The task force does not state that mammography has no benefit in women under the age of 50, just that the decision to start should not be automatic just because you turn 40."
Evans takes a firmer stance. "It's very clear that mortality is reduced if you do annual screening mammography," he says. "Even women in their 40s get a 30% reduction in [breast cancer] mortality. A 30% reduction in the chance of dying from breast cancer is a pretty good deal."