Mammography guidelines spark debate among breast cancer experts

Health experts agree that mammograms can save lives, but they don’t always agree on how often women should have a breast cancer screening procedure or when they should start.

The U.S. Preventive Services Task Force, an influential group of national experts, won praise from its advocates when it recently lowered the recommended age for most women to get a mammogram from 50 to 40 . But it also advised mammograms every two years instead of every year — a decision that left some doctors frustrated and many patients confused.

The American Cancer Society, for example, recommends that women have the option to begin annual screening at age 40, but says they should start getting annual mammograms at age 45.

“It creates tremendous confusion among my patients and among the primary care physicians who refer patients to me,” said Dr. Cindy Lee, chief of breast imaging at Stony Brook Medicine.

In its recommendation, the task force said the evidence demonstrated that biennial screening was a better option to balance cancer detection with the possible harms of false positives. Annual screenings, he points out, could lead to more false-positive diagnoses, possibly leading to unnecessary procedures.

Sometimes a mammogram may reveal a spot or mass, which requires an ultrasound, MRI, or biopsy to determine whether it is benign or cancerous. When it is benign, it is considered a false positive. Studies have shown that false positives can increase patients’ stress levels and even make them less likely to return for regular mammograms.

But doctors on Long Island said it’s best for patients to know there might be something in their breast, then they can discuss options with their doctors.

Dr. Alfredo Torres, an oncologist at NY Cancer and Blood Specialists in Port Jefferson, said he still recommends annual mammograms for average-risk women ages 40 and older.

“We’re seeing younger and younger patients with breast cancer, so I’m not going to change 40 every year,” said Torres, who is also a board member of American Cancer Society of Long Island.

Lee said she believes the more mammograms performed, the more lives can be saved and noted that the possibility of a false-positive result should not deter women.

“I don’t like to compare the sexes, but prostate cancer screening is notoriously full of false positives,” she said. “You don’t hear complaints about men’s anxiety or wanting to cut back on spending.”

Higher LI breast cancer rates

Breast cancer is the second most common cancer among women in the United States, according to the Centers for Disease Control and Prevention, followed only by certain types of skin cancer.

More than 43,100 women died from breast cancer in 2023, according to estimates cited by the task force. Black women are more likely to be diagnosed with advanced breast cancer and about 40% more likely to die from breast cancer than white women. The highest overall rates of breast cancer cases are among non-Hispanic white women, followed by non-Hispanic black women.

Rates of female breast cancer vary by region, with Long Island’s rates higher than New York City and the state.

Nassau County’s breast cancer rate is 145.9 per 100,000 and Suffolk County’s rate is 139.9, according to the New York State Cancer Registry. New York City’s rate is 126.1 and the state’s rate is 134 per 100,000 residents.

Mammograms – an X-ray image of the breast – are a game-changer in efforts to detect these cancers early and treat them. One study found that women who had a mammogram had a 41% reduction in their risk of dying from breast cancer within 10 years and a 25% reduction in the rate of advanced breast cancers.

But there remains debate about how often they should be given to women at average risk. The guidelines are different for women at higher risk – those who have a family history of breast cancer, who test positive for genes linked to breast cancer, or who have previously had radiation treatment to the chest.

The guidelines provide a framework that patients can use when discussing mammograms with their doctors, said Dr. Melissa Fana, breast surgical oncologist and NYU Langone Health director of women’s health for Suffolk County.

“For a woman who is really at average risk, the determination whether it’s every year or every two years is really made in conjunction with her health care provider,” she said.

Fana said she was encouraged by the task force’s guidelines that dropped the age at which women should start mammograms. But she added that it was essential for every woman to know their lifetime risk, which includes factors ranging from age to first menstrual period to whether or not to give birth to family history and race/ethnicity.

“I’m just afraid we’re going to miss people” if women only go every two years for mammograms, said Dr. Monique De Four Jones, deputy chief of labor and delivery at Katz Women’s Hospital – Long Island Jewish Medical Center in New Hyde. Park. “Some people don’t like going to the doctor.”

De Four Jones said biannual visits can be further delayed if women are too busy, centers aren’t accessible and the patient doesn’t have insurance.

Dr. Sophia Fu, director of breast surgery at Good Samaritan University Hospital in West Islip, said annual mammograms make a difference.

“The reason we’ve been so successful in treating breast cancer is because we’re always trying to be one step ahead,” she said. “There are cancers that can develop in less than two years.”

Fana said women need to prioritize their health care and know their family history and personal assessment of breast cancer risk. People most at risk can be screened before the age of 40.

“You won’t miss a mortgage payment,” Fana said. “You shouldn’t miss a mammogram.”