The American Cancer Society says that about 25 percent of women who die from breast cancer were diagnosed in their 40s. Yet, in an unexpected and unfortunate move, the United States Preventive Services Task Force (USPSTF) last week finalized its draft breast cancer screening guidelines raising the age women should begin regular screening from 40 to 50. They did this despite the fact that Congress — led by Sen. Barbara Mikulski — recently passed legislation that prevents these recommendations from being implemented. As a breast surgeon who treats high-risk African American women with breast cancer every day, I can tell you from experience that the release of these guidelines does a disservice to women everywhere.
Although these guidelines legally cannot go into effect, they still put women at risk. Many women are unaware that Congress intervened to preserve women's access to annual mammograms free of charge. However, with national news coverage of the finalized task force guidelines, many women will likely hear that the USPSTF raised the screening age and believe they have to wait until 50 to get their first mammogram. In 2009, when this same task force attempted and failed to execute these same misguided recommendations, we saw a disturbing increase in women delaying their mammograms.
Raising the age to begin screening from 40 to 50 is simply dangerous. We know that lives are saved when breast cancer is detected and treated earlier. In fact, the most rigorous scientific studies have always shown a decline in breast cancer deaths from screening women at age 40. Plus, 50 is not a magic number; none of the parameters of screening change suddenly at the age of 50 or any other age, and there is no scientific or biological reason to delay screening until 50. The truth is, if women who are currently in their thirties were to wait until 50 to be screened every two years, it is estimated that as many as 100,000 women would lose their lives to breast cancer, according to National Cancer Institute's Cancer Intervention and Surveillance Network computer models. These are lives that could have been saved through early detection beginning at age 40.
All women are jeopardized by delaying the onset of screening, but certain populations, including the African American community, are particularly affected. Black women get cancer on average five to seven years earlier than white women and have a 42 percent higher mortality rate. Black women also tend to get more aggressive, faster growing breast cancer and tend to have cancers detected later. What's more, the USPSTF recommendations dismissed new screening technology like 3D mammography, which has been shown to detect more invasive cancers, especially in women who have dense breasts, as many black women do. If the recommendations had not been stopped, this population would have been at an even greater risk of missed cancers and higher mortality rates.
Despite these risks, some critics of congressional intervention say that stopping implementation of the guidelines was unnecessary politicization of this issue. They point to the task force's acknowledgment that when to start screening is an individual choice. However, what these critics fail to mention is that insurance coverage is tied to the USPSTF's "rating." By giving mammograms for women age 40 to 49 a "C" grade, insurance companies would no longer have been required to cover mammograms for this age group. While women could make the individual choice with their doctor, they would still have to pay out of pocket for the exam, which means early detection is a luxury for only those who can pay for it. For many of the women I see, the decision between paying for a mammogram or covering another daily expense is not a choice at all.
Congress' intervention resulted in a necessary "time-out" before these misguided recommendations could be implemented. Thanks to this legislative action, all women can continue to get their annual mammogram free of charge for the next two years, while the medical community addresses the numerous concerns about the recommendations.
As someone who cares for patients whose lives are saved by early detection every single day, I can't emphasize enough how important it is that women continue to screen early and often. If we can't find it, we can't treat it, and I believe every woman, regardless of financial status or demographic should have a fair shot at catching cancer in its earliest stage.
Dr. Regina Hampton is a board certified breast surgeon and co-Founder of Breast Care for Washington, a nonprofit dedicated to mammography access. She practices in Prince George's County at Doctors Community Hospital. Email: firstname.lastname@example.org; Twitter: @drreginahampton.