You may recall the conflagration ignited by the U.S. Task Force when it made its inflammatory recommendations in November 2009 regarding mammogram screening.   I sure do because all hell broke loose in my office!  My patients and my colleagues were aghast.  If you've forgotten the details, here's what this committee, convened by the Department of Health and Human Services (HHS), had to say about the value of annual mammogram screening for women age 40 and older:

For biennial screening mammography in women aged 40 to 49 years, there is moderate certainty that the net benefit is small.

For biennial screening mammography in women aged 50 to 74 years, there is moderate certainty that the net benefit is moderate.

The Task Force then recommended that America drop annual mammogram screening for women in their forties and reduce screening women 50-74 to every other year.  They determined that the overall benefit of screening - saving one life in every thousand women diagnosed with breast cancer - was insufficient when compared to the costs and other risks involved.  They made it very clear that they were the experts and they had reviewed all the literature on the subject, and though it might be a difficult pill to swallow, we should all try to choke it down nonetheless.

Women and radiologists from coast to coast went up in smoke, as did the American Cancer Society. And for good reason:  there were good data to support the overall benefit of mammogram screening for saving lives.   Within three days, the Secretary of HHS, Kathleen Sebelius, with flames engulfing her on all sides, made it clear that the federal government would not implement the recommendations put forth by the Task Force.  And then everyone went home.  And my office settled down.  And the smoke cleared, except for a recalcitrant multitude, including Dr. Susan Love's Army of Women, who still maintained that mammograms don't really save lives, or enough of them to warrant their widespread use as a screening method for women 40-49.

At the time, my reading of the scientific literature and overall position concerning the value of annual mammogram screening for women over the age of 40 aligned with the American College of Radiology:  do it, they save lives!  I also held the position that as mammogram screening was the best screening method we had for early detection of breast cancer -  the most common malignancy in women - we should not abandon it until we had something better to replace it!

Mercifully, new and strong (irrefutable) data have just been released that should end the argument, once and for all, that mammograms don't save enough lives.  (Don't even get me started on how important they are in saving breasts!)  A study just published in Radiology reports that after following 133,000 women, age 40-74, for twenty-nine years, the benefit of annual screening mammography confers a 30% reduction in deaths from breast cancer, a benefit that became more pronounced the longer the women were observed! 

Here are the details of the study:

Women aged 40-74 were invited for annual mammogram screening and compared to women who were not.  Approximately 133,000 women were involved in this study that screened women for seven years and then followed everybody for twenty-nine years.  The results showed that women who were screened had a 30% reduction in breast cancer deaths and that this benefit persisted and got stronger year after year.  Overall, annual screening mammogram in women age 40-74 prevented one cancer death for every 414-519 women screened.  

For the 150 million women now living in the United States, that is significantly good news.

Looking to the next horizon:

We need a better screening method.  Mammograms do not detect approximately 10% of breast cancer.  Mammograms often demonstrate abnormalities that are ultimately found to be benign but trigger multiple expensive diagnostic tests, accompanied by palpable levels of stress while the process of discovery unfolds.  With breast cancer cases set to explode in conjunction with the graying-out of 35 million baby-boomer women, the costs involved are themselves going to explode.

So let's stop arguing about what's in the rear view mirror and let's find a better screening method for early detection of breast cancer.

Better yet, let's fund Professor Pogo's work (Mt. Sinai School of Medicine) on the breast cancer virus, so we can nail that argument down once and for all.  And let's fund Professor Vincent Tuohy's (Cleveland Clinic) first preventive breast cancer vaccine, so we can put all the mammogram machines and everything else that is pink into the basement of the Smithsonian Institution, next to the iron lungs and the old bones of dinosaurs.

Reference:

Tabar et al, Swedish Two-County Trial:  Impact of Mammographic Screening on Breast Cancer Mortality During 3 Decades. Radiology, 2011.