I recently told a 74-year-old patient that her mammogram was normal. “Great,” she said. “My doctor told me that I don’t ever need a mammogram again. Guess I’m too old.”
What? No!
For context: I am a physician; specifically, a diagnostic radiologist whose expertise is finding breast cancer as early as possible. “Early” means more likely to be small, early stage and treated effectively with less aggressive therapies, possibly even cured. Early means optimizing quality and quantity of life. For women at average risk, the best way to achieve early detection is with screening mammograms performed every single year starting at age 40, and with no age endpoint unless the woman is in poor health. Please note that recommendations are different for high risk women.
So, why are some doctors and news media unintentionally misleading older women like my patient? Why are they giving false assurance that it’s OK to abandon screening at 75?
Some are misinformed that cancers in these women grow so slowly that they’ll die of something else first. That’s false. The average life expectancy of a 75-year-old woman in the U.S. is 87 years old, per the CDC.
Many are also misled by the United States Preventive Services Task Force (USPSTF).
The USPSTF — a 16-member panel that advises our federal government on disease screening, counseling and preventive medications for the entire U.S. population — claims that the current evidence is “insufficient to assess the benefits versus harms” of screening mammography for women over 74, and therefore, they don’t recommend it.
Is this appropriate? Ask Dr. Daniel Kopans, MD, FSBI, FACR, Professor of Radiology at Harvard Medical School, an internationally respected breast cancer screening expert, the inventor of “3D” mammography and, at age 76, a tireless advocate for women’s health.
Dr. Kopans recently told me: “The age of 74 was chosen only because randomized, controlled trials, which are the proof of benefit, included women ages 40-74. These trials are expensive to run, and funding was limited.” The USPSTF did not choose that age because there’s any evidence that screening mammograms don’t save lives past 74.
Less than a year ago, the USPSTF lowered the recommended age to start breast cancer screening to 40. The American College of Radiology, the expert in breast cancer screening, has been advising women to start at age 40 for more than 60 years. Kopans was on the ACR Breast Cancer Task Force in 1980. As he can attest, this was the ACR screening recommendation then, and it has not changed since.
“The research studies deemed high-quality enough to inform medical practice have repeatedly proven that we can save the most lives at all ages by early detection,” he told me.
But the USPSTF’s name, media presence and power (effectively mandating which services must be covered by insurance companies) make it seem like the leading expert, right? Well, not one USPSTF member is a doctor whose expertise is the diagnosis or treatment of breast cancer. So, we should all be asking, why are they deciding which women to screen and when?
The numbers transform into faces for a breast radiologist.
Early in my profession, I read the mammogram of an 83-year-old. She’d been diagnosed with a small cancer four years prior thanks to an annual mammogram. I walked into the exam room to tell her that today’s mammogram was normal and noticed she was the picture of health. Since finishing her treatment, she’d been on two cruises with her daughter and had another one planned.
In contrast, I more recently met a lovely 80-year-old woman who hadn’t had a mammogram in years. She had several tumors, one so large that it was visibly deforming her breast.
I suspect there’s also a component of ageism involved here: Why does our society expect less of “old people” instead of honoring and valuing them? To me, it seems irrational, unethical and sad.
Over the past 40 years, screening mammograms have played a major role in decreasing the number of deaths due to breast cancer in the U.S. by more than 40%.
Utah has the third-lowest breast cancer screening rate in the country. Only 65% of Utah women get annual mammograms versus the national average of 72% (both far from 100%).
Let’s inform women of all ages when it’s appropriate to get a mammogram and encourage them to do so if it is.
Ally Parnes
Allyson Parnes, M.D., is a diagnostic radiologist specializing in breast imaging, a breast cancer survivor and a patient advocate who lives and practices in Utah.
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