Back in 2009, the U.S. Preventive Services Task Force (USPSTF) recommended that breast cancer screening using mammograms should begin for women at age 50. The panel has clarified that recommendation, saying that women between 40 and 49 years old may also benefit from the screening, if seen as needed by their physicians.
Other experts have criticized the USPSTF recommendation, pointing out that defining 50 years old as the starting point for screening will jeopardize insurance coverage for women, millions of which are between the ages of 40 and 49. The panel, however, pointed out that the recommendation it made was simply a draft.
According to Dr. Richard Wender, American Cancer Society chief cancer control officer, had the recommendation been final, it will mean the end of coverage for mammograms under the Affordable Care Act (ACA).
The ACA stipulates that preventive services will only be covered if they are assigned with at least a grade of "B." The USPSTF draft recommendation assigned mammogram screening for women between the ages of 50 and 74 every two years with a "B," while screening for those in their 40s was given a "C." A "B" means the service has to be offered by doctors while a "C" means the service may be offered but only to select patients depending on their individual circumstances.
Using a model, the USPSTF projected that, over a lifetime, recommending mammogram screenings for women aged 50 to 74 every two years will prevent seven breast-cancer related deaths for every 1,000 women tested. If screening was started at age 40 and continued every two years, eight deaths could be prevented for every thousand women thousand while generating 576 false-positive results.
Combining clinical trial results showed that over the course of 10 years, mammogram screening can prevent four deaths for every 10,000 women aged 40 to 49, between five and eight deaths for those 50 to 59 years old and up to 21 deaths in women between the ages of 60 and 69.
This is in line with what Dr. Michael LeFevre, a family medicine professor from the University of Missouri School of Medicine and USPSTF chair, said about the value of a mammogram increasing with age.
Still, it cannot be denied that starting screening early at 40 years old has the potential to save lives. The option must at least be opened to women after providing female patients with the information they need to decide whether or not to undergo a screening.
Photo: NASA Goddard Space Flight Center | Flickr
