The timetable of when a woman should get her first mammogram has long been up for debate.
Some organizations and medical professionals argue a woman should start at 40 years old whereas others say 50 is early enough and proven to allow enough time to save lives.
Dr. Alan Hollingsworth, medical director for Mercy Women’s Center and Breast MRI of Oklahoma, answered a few questions about his perspective on when women should start being screened for breast cancer.
Q. When did this debate begin?
A. In 2009, the U.S. Preventive Services Task Force recommended against routine screening mammography among women 40 to 49 years.
Hollingsworth said most people think this is when the debate over breast cancer screenings began, but that’s not the case.
For example, in the early 1990s, the National Cancer Institute changed its position on the age at which a woman should be screened for breast cancer, and that produced similar outcry to the present-day debate over screening ages and timelines, he said.
Hollingsworth said he thought allowing the U.S. Preventive Service Task Force so much power in the conversation on screening guidelines was puzzling.
“It takes the people who know all of the nuances out of the picture, and you really have epidemiologists dictating how we practice medicine,” he said.
Q. What are the main issues around breast screenings on which scientists and doctors disagree?
A. The main points of contention exist over at what age — 40 or 50 — a woman should start being screened for breast cancer and how frequent she should be screened, once a year or every other year.
People often forget that most insurance companies weren’t willing to cover mammography until they were required by law to do so, he said. Mammography costs insurance companies billions each year, he said. If mammograms were cheap, there wouldn’t even be a debate over when to screen women, he said.
“Insurance companies ran the numbers, and figured out that it’s easier to treat cancer when it arises than screen for it,” he said.
Hollingsworth said he disagrees with the task force’s recommendation and said he agrees with the American Cancer Society’s guidelines — that women age 40 and older “should have a mammogram every year and should continue to do so for as long as they are in good health,” the society recommends.
Hollingsworth said he acknowledges the concern around false positives and the stress women feel before they get their biopsy results.
“It’s a judgment call,” Hollingsworth said. “It depends on how you weigh a benign biopsy and putting somebody through a benign biopsy — how many of those does it take to balance out a life saved? That’s what people are trying to do right now, and there’s just no way to do that.”
Q. When did screenings first gain momentum?
A. Screening for breast cancer started gaining momentum in the 1970s. Attention grew even more in the 1980s — and with that, came the overselling of mammograms, Hollingsworth said.
Overall, the benefit of mammography was oversold, he said. Women often believe that mammography saved their lives, and that’s not always the case, he said. The highest estimates are that one-third of breast cancer patients had their lives saved because their cancer was found through mammography, he said.
“In 1,000 mammograms, you’ll find five to 10 cancers, but ... that doesn’t mean every single person had their lives saved,” he said. “Some cancers are aggressive, and some will end in a death anyway. And you’ll have others that are so slow growing they would have been cured anyway if you had waited until you felt it.
“There’s this middle group of the ones you happen to catch at just the right time that would have eventually been fatal ... and that middle group is actually the minority, and that’s a concept people don’t appreciate and why mammograms get oversold.”