“Mammography and the Corporate Breast” is the best commentary I’ve seen on the recent breast cancer screening guidelines issued by the U.S. Preventive Services Task Force. It’s posted on the Hastings Center Bioethics Forum, by Adrienne Fugh-Berman, MD, of Georgetown University Medical School, and Alicia Bell of the National Women’s Health Network.
The authors are responding to a firestorm of criticism of the guidelines, which recommend a policy that encourages women to start routine mammograms at age 50 (rather than the current 40) and to have them performed every other year rather than annually.
Fugh-Berman and Bell take particular aim at the attacks emanating from doctors directly profiting from the multibillion dollar mammogram industry. It’s worth reading their whole article, but here’s the part where they point out that mammograms themselves are not risk-free.
Unlike Pap smears and prostate exams, mammography is not a benign screening technique. Mammograms utilize x-rays and are known to increase the lifetime risk of breast cancer, especially in younger women. A case-control study in 1,742 women under the age of 50 with breast cancer found that, compared to 441 controls, multiple mammograms five or more years prior to diagnosis almost doubled breast cancer risk. A U.K. study estimated that annual breast cancer screening starting at age 40 would increase radiation-induced breast cancer mortality by 0.5 per 100 women screened. That’s five times the increase in radiation-induced breast cancer mortality when annual screening started at age 50 (0.11 per 100 women screened).
Mammograms are far more accurate in women over 50, and so the benefits outweigh the risks. Mammography is also a useful tool in younger women with suspicious lumps or a family history of breast cancer.
