Editor’s note: Henry Izawa is president and CEO of FUJIFILM Healthcare Americas Corporation, a manufacturer of digital imaging devices, including those used in mammography.
Many women put off breast exams because they are afraid. In fact, breast cancer is one of them most feared cancer among women. According to one recent study, only approx 50% of American women over 40 are at or below the poverty line have had a mammogram in the last two years, which is considerably below the national average 65% of women over 40 years old.
Impressive panel from US Preventive Services Task Force (USPSTF) now plans to formally recommend that breast cancer screening for women begin at age 40 rather than at age 50, which was its previous recommendation. The new one draft proposal also recommends that screening continue every two years until age 75.
While this is a step in the right direction, the upcoming recommendations do not go far enough. The American Cancer Society has advocated for years that the risk is too great for most women and that an exam once a year is still the best course for most people over forty.
The original, controversial call by the Preventive Services Task Force several years ago to reduce annual screenings was motivated by the belief that breast cancer was being overdiagnosed. On the other hand, new compelling evidence suggests that black women tend to develop fast-aggressive breast cancer earlier than white women—and die more often from such cancer. The American Cancer Society’s Better Understanding recognizes that a 24-month interval does not capture the latest research and could further increase disparities and mortality.
The good news is that more and more women are seeking routine breast cancer screening after a a big drop during the height of the COVID-19 pandemic.
For women who may be anxious about getting their first mammogram at age 40, we should use this opportunity to help them understand that today’s annual experience is more effective and convenient than it has ever been because of new added conveniences for patients .
But crucially, overdiagnosis is no longer as much of a concern, as a number of new technologies and techniques also make mammograms far more accurate and reliable.
First, consider image quality. Three-dimensional (3D) mammography, also known as digital breast tomosynthesis (DBT), creates a three-dimensional image of the breast using X-rays. 3D mammography has been shown to have advantages over traditional 2D mammography. All women – whether they have fatty or dense breast tissue – can benefit from an exam with a 3D mammogram, which takes several pictures of the breasts from different angles.
The second advancement is the convenience factor. Many women delay mammograms because they worry it will be a painful experience. Making the mammogram experience as pleasant as possible could help increase screening compliance among women.
Newer mammography systems now recognize the differences in breast density and have the ability to adapt as the nature of each breast tissue is identified and analyzed. This is very important because breast density can make malignancies more difficult to detect and associate higher risk of breast cancer.
But despite 3D mammography’s ability to detect more breast cancers than 2D imaging alone, it doesn’t fully address the challenges of imaging dense breasts. This is another area where the task force falls short in its recommendations designating individuals with dense breasts and a family history of breast cancer as “average risk.”
The data shows that women with dense breasts are in increased risk of breast cancer. Combine dense breasts with family history or other risk factors and these women show up high risk criteria. The American Cancer Society, the National Comprehensive Cancer Network, and the American College of Radiology state that mammography alone is insufficient to identify this patient population and that additional screening methods, including are considered.
There’s no doubt that today’s technology is improving the screening experience and breast cancer detection, but to have the best chance of saving lives, we need to ensure that women are screened in time to make a difference. It starts at the age of 40, on an annual basis.
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