Dr. Sledge, breast cancer expert, writes about new mammography guidelines

The following appeared in The Indianapolis Star on Sunday, Nov. 29.

For years, women have been urged to start getting an annual mammogram once they reach age 40.

That all seemingly changed on Nov. 16 when the U.S. Preventive Services Task Force (USPSTF) -- which was formed to periodically review available data and develop recommendations -- announced new guidelines. The task force last issued  recommendations seven years ago; at that time, its recommendations were the same as those of the American Cancer Society (ACS).

The new recommendations are:

  • Women ages 40 to 49 do not need a mammogram. Women ages 50 to 74 should be screened every two years
  • Women do not need to do breast self-examinations
  • Women ages 75 and older do not need a mammogram as there is insufficient evidence that they are effective for women at this age

However, these new recommendations differ from those by the ACS, which women have become familiar with over the years. The ACS recommends:

  • Annual mammography screening for women, beginning at age 40, who are at average risk of breast cancer
  • Breast-self examinations are optional for breast cancer screening

Both sets of recommendations are for women at average risk. Of course, not every woman is at average risk of developing the disease.

With the different recommendations, what should women do?

They should know that screening mammography decreases breast cancer mortality. Mammography, which does have some limitations, currently is our best defense against breast cancer. 

Women, regardless of their age, should talk with their doctors about mammography to see if it is right for them. Women also need to be familiar with their bodies. If they notice a lump, a depression in their breast tissue, a mass, or a new area of tenderness, they should get it checked promptly. Also, women need to know about family history. A woman is at greater risk of developing breast cancer if she has one of the following:

  • A personal history of breast or ovarian cancer
  • A close relative who was diagnosed with breast cancer before menopause or in both breasts

The greatest risk for developing breast cancer is age. It is relatively uncommon in women under age 40, while it is much more prevalent among women age 60 and over. It also affects Caucasian women more than African Americans, but the latter have higher mortality rates.

Overall, according to the National Cancer Institute, breast cancer is the most frequently diagnosed non-skin cancer in American women. An estimated 194,000 American women will be diagnosed with breast cancer this year and an estimated 41,000 will die of the disease. This includes about 400 breast cancer deaths in men, or about 1 percent of all breast cancer deaths.

We live in an era where we have far more to offer women with breast cancer than ever before. We live in an era where our ability to screen for breast cancer has gotten better than ever before. We live in an era where there is the prospect for new diagnostic and therapeutic technology for breast cancer. But we also live in an era in which about one-third of women never have a mammogram. Some are simply unaware that screening mammography saves lives, so we in the medical community need to do a better job of educating women. And you can do your part: Tell your mothers, sisters, daughters, and girlfriends about the risks and warning signs of breast cancer and the importance of mammography screening. 

George W. Sledge Jr., M.D.
Ballve-Lantero Professor of Oncology
Professor of Medicine and Pathology
Indiana University School of Medicine
Indiana University Melvin and Bren Simon Cancer Center