Breast cancer is a serious and often fatal disease. In the U.S., a woman is diagnosed with breast cancer every three minutes. In 2009, the most recent year for which numbers are available, 40,170 women died from breast cancer.
Fortunately, the U.S. death rate from breast cancer has decreased by 30% since 1990. Early detection deserves much of the credit.
For the majority of women diagnosed with breast cancer, their first indication of the disease came through a routine mammogram. These scans allow doctors to discover tumors while they’re very small and most responsive to treatment.
Widely accepted scientific studies have documented that the use of screening mammography causes a significant reduction in mortality from breast cancer between age 40 and 50. That’s why the American Cancer Society, National Cancer Institute, Susan G. Komen network and other important health organizations strongly recommend that women with normal risk begin annual screening mammography at age 40.
Decline in Screening
Unfortunately, there has been a decline in the number of women having screening mammograms. Observers believe this has been caused by confusion related to a controversial study released in 2009 by the U. S. Preventive Services Task Force (USPSTF). That study confirmed that mammography saves lives, but essentially said not enough lives were saved in the 40-49 age group to outweigh the costs of providing screening mammograms for those women.
This study got widespread media attention. The situation got very confusing when the study’s recommendations were rejected by major medical organizations including the American Cancer Society, the National Cancer Institute, the American College of Obstetricians and Gynecologists and the American College of Radiology.
Study Results Criticized
The USPSTF results were criticized by major medical organizations because of flaws in the study design. The USPSTF used a computer model instead of the data from the two largest randomized, controlled studies that used actual women. Computer models are only as good as the assumptions that are programmed into them. The model assumed that screening mammography resulted in a decrease in mortality of 15%, not the scientifically supported 30%. The study also failed to take into account the improved resolution and earlier detection afforded by using digital mammography.
The USPSTF quoted supporting data from a 1981 Canadian study that had serious flaws. First, that study was not blinded. (In a blinded experiment, some of the persons involved are prevented from knowing certain information that might lead to conscious or unconscious bias on their part, which would nullify the results.) Second, the study used poor quality mammography. Third, patients who had tumors discovered through a physical examination (some of which turned out to be large cancers) were automatically placed in the screening mammography group. It was incorrect to include such patients in the “screening” category since that group was for patients without any symptoms. This made it appear that mammography was not as effective in detecting breast cancer in its earlier stages of development. It also made mammography’s reduction in mortality look lower. Patients with breast lumps should have been placed in a separate category.
The USPSTF also quoted supporting evidence from an article in the Journal of the American Medical Association that lumped women ages 30-40 in with women aged 40-50. This lowered the incidence rate of breast cancer in the whole group. However, it is well-documented that the 30-40 age group has a lower rate of breast cancer than the older 40-50 age group and that the younger 30-40 group does not receive a statistically significant benefit from screening mammography. Adding the two age groups together made a gradual increase in cancer rates up to age 50 appear as a sudden increase at age 50.
Screening Should Start at 40
Unfortunately, the highly public and complicated arguments about the study results caused misunderstanding to spread, with some women believing the study said that mammograms are not useful until the age of 50.
Nothing could be further from the truth.
Women should continue to start their screening mammograms when they turn 40. How important is starting at 40? In 2009, 42 percent of the women diagnosed with breast cancer at Boulder Community Hospital were under the age of 50. In fact, greater than 40% of the years of life lost to breast cancer are in women who were diagnosed in their 40s.
The American Cancer Society and National Cancer Institute both strongly recommend starting routine screening mammography at age 40. The health insurance industry continues to cover screening mammograms for women starting at age 40.
Mammography is the best test we have for screening women with a normal risk. Recent advances in digital mammography have made this test even more accurate.
Digital Mammography at BCH
Boulder Community Hospital provides state-of-the-art, low dose digital mammography at four locations – Boulder Community Foothills Hospital in Boulder, Community Medical Center in Lafayette, Boulder Medical Center in Boulder and Medical Imaging Center in Broomfield.
Each facility offers experienced female mammography technologists. Scans are reviewed by experienced radiologists who have been certified in mammography by the American College of Radiology and the federal Food and Drug Administration.
In addition, Boulder Community has an on-site medical physicist who is constantly monitoring image quality and radiation dose levels in order to maximize safety for patients.
All of Boulder Community’s imaging departments have been accredited by the American College of Radiology, an important “seal of approval”.
Scheduling a Mammogram
Most health insurance plans cover mammography -- check your coverage – and you don’t need an order from a doctor to get the test. Funding is available for the uninsured.
- To schedule an appointment at Foothills Hospital in Boulder or Community Medical Center in Lafayette, call 303-440-2170 between the hours of 8 a.m. and 5:30 p.m.
- To schedule an appointment at Boulder Medical Center in Boulder, call 303-440-3029 between the hours of 8 a.m. and 5 p.m.
- To schedule an appointment at Medical Imaging Center in Broomfield, call 303-466-1234 between the hours of 7:30 a.m. and 5 p.m.
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