As a woman, I am keenly aware of the many decisions – simple and complex – that we make every day about our own personal health. As a physician who counsels women, I want to provide the best advice to help my patients lead longer, healthier lives. Like other health professionals, I want my advice to be grounded in the available science. I also want to make sure I share everything a woman can expect as a result of taking my advice – both the benefits and harms – to empower her to make the right decision for herself.
Last week, my colleagues and I, as part of the U.S. Preventive Services Task Force, shared new draft recommendations on breast cancer screening. Our recommendations are based on an in-depth review of the strongest available science regarding mammography. Our goal is to provide women and their primary care clinicians with unbiased, comprehensive recommendations so each woman can make an informed decision about what is right for her.
Here’s what we found:
- A mammogram is a good test, but not a perfect one. Studies tell us that mammograms can help women ages 40 to 74 lower their chance of dying from breast cancer. The benefit of screening increases with age. But even with advances in technology, this benefit does not come without harms. The most serious potential harm is being diagnosed with a cancer that would not become a threat to you during your lifetime. This is called “overdiagnosis,” and it may result in women going through treatment for breast cancer unnecessarily. Another common potential harm is false-positive tests that can lead to unnecessary breast biopsies and can cause stress and anxiety.
- Mammography is most effective for women ages 50 to 74. In this age group, women get the best balance of benefits to harms when they get a mammogram every two years. Women 75 years and older were not included in enough studies to give us a definitive answer about the benefits and harms of screening. We encourage older women to consider their own health status and talk with their doctors about the potential benefits and limitations of mammography.
- Women ages 40 to 49 should consider whether screening is right for them. There are important benefits and harms, and women should make the decision that’s right for them based on their own values, preferences and health history. Women who have a mother or sister with breast cancer may benefit more than average-risk women by beginning screening in their 40s.
It’s important to note that these recommendations are intended for women age 40 and older who don’t show any signs of breast cancer. For example, they are not intended to guide a woman who has found a lump in her breast. Likewise, these recommendations aren’t meant for women who have a mutation in one of the “breast cancer genes,” BRCA1 and BRCA2. These women should talk to their doctors about screening recommendations.
We have published our findings in draft form to allow others to review the recommendations, along with the science that informed them. We hope you’ll add your voice to this important dialogue by commenting online at screeningforbreastcancer.org.
The task force cares about the health of all Americans. We hope everyone agrees that reliable information about the science is critical. We are glad that our nation’s leaders passionately view preventive services as an important cornerstone of our health-care system. Our role is to comprehensively review the science to understand which preventive services are effective. As clinicians, we also hope that our nation will continue to strive to help all individuals get access to those preventive services that can enable people to live healthier, longer lives.
Kirsten Bibbins-Domingo is vice chair of the U.S. Preventive Services Task Force, an independent group of doctors and health-care experts that last week updated its recommendations on screening for breast cancer.