"Should Women Get Mammograms Starting at Age 40?"
Various health organizations “offer clashing
mammogram recommendations”
that range from the annual mammograms starting at age 40
to eliminating routine mammograms altogether.
It’s hard to know who to trust
given all the various conflicts of interest,
but a good place to start is the USPSTF,
the U.S. Preventive Services Task Force,
whose 2009 recommendations ignited a firestorm of controversy
by recommending pushing back routine mammograms
from age 40 to 50 and doing them every other year
instead of annually.
This evoked a swift and decidedly passionate condemnation
from members of the public, the media, and medicine.
Most people have never even heard of the USPSTF,
but it’s considered the leading independent
panel of nongovernmental experts when it comes to prevention,
considered the gold standard for preventative care,
since they have a reputation of sticking more with the science,
for example, recommending against teaching
women to do breast self-exams.
Why?
Because it doesn’t appear to work.
It was put to the test— hundreds of thousands of women
randomized to do self-exams or not,
and no benefit, in fact, only harms,
doubling the number of women
who had to get biopsies taken,
but not actually shown to decrease
the risk of getting breast cancer, or dying from breast cancer.
It didn’t catch tumors in earlier stages.
Now, to be clear, they didn’t come out against breast self-examination,
but against teaching women how to do them,
reminding them to do them,
only appears to cause harm with no benefit.
If you do discover an abnormality,
then definitely tell your doctor,
but telling women to get in the practice
of looking seems to do more harm than good.
Yet, most doctors continue to teach women to perform self-exams.
But wait, it’s not been shown to help,
and in fact, has been shown to harm.
So why do doctors keep doing it?
Because that’s just what we’ve been telling women forever.
So, there’s this medical inertia that may trump
women’s health—even without a multi-billion dollar industry
pushing for the practice to continue.
Even without Big Business tipping the scales.
Now, consider mammograms...
Billions of dollars of revenue every year
from sticking with the status quo.
Maybe the $7.8 billion spent annually on mammograms
“might be better spent on something else.”
“Of course, one person’s cost is another person’s income.”
These billions of extra dollars from the status quo
may best explain the organized resistance
to the USPSTF panel conclusions.
For example, breast radiologists, denounced the panel,
“implying that the panel members were guilty
of a callous disregard for the life and well-being of women,”
all while the American College of Radiology
is receiving millions of dollars of donations
from mammogram machine manufacturers.
Yeah, but in the case of self-exams,
it was put to the test, and the science was clear.
It’s a no-brainer that harms outweigh the benefits
when apparently there are no benefits.
And, the same appears to be the case
with starting mammograms at age 40.
It was put to the test to specifically address
“the population-wide efficacy of mammography screening"
starting at the age 40,
and it started out looking like it might help,
but ultimately failed to show any benefit
in terms of lowering one’s risk of dying from breast cancer.
Instead, they just found harms, so-called over-diagnosis,
all the chemo, radiation, and surgery
from the detections of what looked like cancer,
but may have never caused any problems
had they never been picked up.
So, it may have just resulted in like unnecessary mastectomies;
yet, when the USPSTF tried to explain that
again in their 2016 recommendations,
the firestorm was reignited,
with full-page ads taken out in major papers asking,
“Which of our mothers, wives, daughters, and sisters
would it be OK to lose?”
But, that misrepresents the science.
Disrespecting women, rather than saving their lives.
It’s time to douse the flames, clear the smoke,
so we can clearly see what the evidence shows.
Evidence schmevidence, said Congress,
who snuck in some language to interpret
any reference to “current” USPSTF
breast cancer screening recommendations
to mean those issued “before 2009”—
in other words, its 2002 recommendations
that recommended annual mammograms starting age 40.
Essentially, Congress is requiring health insurers
to ignore modern scientific assessments
and instead use a 15-year-old guidance.
“Although many women’s health advocates
applauded the congressional mandate,
it could be viewed as undermining women’s rights
"to make informed decisions based on the best scientific evidence.”
The same thing happened 20 years ago
when a National Cancer Institute consensus panel
arrived at the same conclusion,
but the Senate voted unanimously to ignore them.
The number one killer of women is heart disease.
Why not focus our billions on more effective interventions?
Since health care dollars are limited,
maybe we could be doing more for women’s health.
But hey, it could have been worse.
The original bill would have denied funding
for any future USPSTF mammography recommendations period,
and some members of Congress even proposed to alter
the Task Force’s composition to include stakeholders
from the mammogram machine manufacturers,
so they can play more direct role in influencing policy.