BIRMINGHAM, Ala. - The University of Alabama at Birmingham (UAB) Comprehensive Cancer Center strongly supports the recommendations of the American Cancer Society that women should begin mammography screening at age 40 and continue on an annual basis as long as they are in good health, says Edward Partridge, M.D., center director.
"The take-away message is that each woman needs to consider her individual benefits and risks and discuss them with her health care provider when it comes to decisions about breast cancer testing and screening," Partridge says. His comments came after the announcement of the U.S. Preventive Services Task Force (USPSTF) decision to push back its guidelines on initial mammograms to age 50 and conduct follow-ups every two years.
Recommended annual mammography and clinical breast examination for all women beginning at age 40 is the best advice, says Helen Krontiras, M.D., co-director of the UAB Breast Health Center and a scientist at the UAB Comprehensive Cancer Center.
"Mammography is a screening tool, and it is the best screening tool that we have right now," Krontiras says. "It is minimally invasive, it is cost-effective, and it really has very few, if any, side effects.
"Mammography does not prevent breast cancer from happening, but it tries to find breast cancer early - when it's treatable and when it's curable," she says.
Otis W. Brawley, M.D., chief medical officer of the American Cancer Society, says his group reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, he says, reasonable experts can look at the same data and reach different conclusions.
In 2003, an expert panel convened by the American Cancer Society conducted an extensive review of the data available at the time. Like the USPSTF, the society's panel found convincing evidence that screening with mammography reduces breast cancer mortality in women ages 40-74, with age-specific benefits varying depending on the results of individual trials and other analysis.
Like the USPSTF, the American Cancer Society panel also found that mammography has limitations - some women who are screened will have false alarms, some cancers will be missed, and some women will undergo unnecessary treatment. These limitations are somewhat greater in women in their 40s compared with women in their 50s, and somewhat greater in women in their 50s compared with women in their 60s.
"But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives," Brawley says. "As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member."
The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group, yet screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. The UAB Comprehensive Cancer Center, the American Cancer Society and numerous other professional and advocacy groups feel that in both cases, the lifesaving benefits of screening are worthwhile.
Surveys of women across the nation and in Alabama show they are aware of mammography's limitations, but that they also place high value on detecting breast cancer early, Krontiras says.
Screening technology is improving as well. As Brawley says, "Data show the technology used today is better than that used in the studies in this review, and more modern studies show that mammography is achieving better results than those achieved in these early experimental studies that go back as far as the mid-'60s."
About the UAB Comprehensive Cancer Center
The UAB Comprehensive Cancer Center is among the 41 cancer centers in the nation to meet the stringent criteria for the National Cancer Institute's comprehensive designation. The center is a leader in groundbreaking research, reducing cancer disparities and leading-edge patient care.
Media Coverage of New Mammography Guidelines Confusing to Some, Says UAB Expert
BIRMINGHAM, Ala. - The public may have problems this week sorting through news articles about a government task force's opposition to routine mammograms for women under 50 and articles about breast cancer survivors touting the benefits of early mammograms. But to properly interpret the news, the public must learn to balance the research with the anecdotal evidence says University of Alabama at Birmingham (UAB) Associate Professor of English Cynthia Ryan, Ph.D.
Ryan studies how breast cancer is portrayed in the media and is the author of a forthcoming book on the rhetoric of breast cancer in popular women's magazines.
"I think that news coverage on this recent debate has been fairly effective, but as expected, there is room for readers to misinterpret what they are reading," says Ryan, who points to two New York Times articles published on the same day: one dealing with the findings of the U.S. Preventive Services Task Force (USPSTF) arguing that routine mammograms should begin after age 49, and another article offering one woman's stance that early mammograms save lives.
"I'd say the media is doing a decent job of covering both sides of the debate," says Ryan. "What can be problematic for readers, however, is the seeming contradiction between two polarized perspectives: either keep the screening guidelines the same or change them.
"Consumers are best able to make sound decisions about their health when these polarized messages are integrated and reflect the complexity of the disease," she says. "It's not an either-or conversation."
Ryan says that when confronted with extreme representations, there is a part of the human brain that wants to go with scientific study "because we figure it must be credible and rational," she says. "But another part of our brain embraces anecdotal advice that links the message with a face.
"Not surprisingly, consumers are torn. But informed health consumers have to take in both kinds of evidence. Both are credible and offer a needed perspective that can affect decision-making."
The bottom line, says Ryan: Look at all of the evidence, the research and the anecdotes as part of one big conversation as opposed to conflicting advice. You'll be better informed when making a decision that's right for you.
"Read all of the coverage," she says. "Talk to your doctor. Know your risk factors. Understand that you are going to face different kinds of advice and you have to weigh those and determine what the best choices are for you."
About the UAB Department of English
The UAB Department of English offers an undergraduate degree in English with concentrations in creative writing, linguistics or professional writing and public discourse, and graduate degrees in literature, rhetoric and composition, and creative writing.