RSNA: Defending more aggressive breast cancer screening intervals

CHICAGO—Despite suggested guidelines from a federal task force for women to wait until 50 years old to begin breast cancer screenings, one presentation at the annual meeting of the Radiological Society of North America (RSNA) argued that data clearly show more lives are saved when annual screenings begin at age 40.

In 2009, the U.S. Preventive Services Task Force (USPSTF) announced that mammography screenings should not begin for women until age 50 and only occur once every two years after that. However, Daniel Kopans, MD, a professor of radiology at Harvard Medical School, noted the USPSTF admitted that reducing screening to only once every two years prevented false positives, it also could mean more cancer-related deaths.

“When you look at data from ages 40 to 49 and then at everyone from ages 50 to 74, it looks like there’s a sudden jump in cancer rates and we need to understand what effect that has,” Kopan said.

He argued that looking at cancer rates in that light makes it look like there is something that happens to cancer risk for women when they reach aged 50.

“There’s just no evidence that this happens,” Kopan said. “Women are just as likely at 52 as they are at 42 to get cancer. Age 50 is a myth when it comes to breast cancer screening benefits and there is zero data that something changes suddenly at 50, or any other age for that matter.”

Kopans said when the USPTF guidelines were released, a number of radiologists across the country wrote responses and submitted them to medical journals across the country.

“We were letting them know the new guidelines were doing a major disservice to women,” he said.

Kopans’ own responses to the guidelines were turned down by a number of major journals, including the New England Journal of Medicine. He also said other major journals published editorials stating that radiologists had a conflict of interest disagreeing with the 2009 guidelines and that the only opposition to these guidelines were “anecdotal, emotional politics.”

“Major medical journals in this country are preventing an open discussion of important information,” he said.

Another argument that came from the USPSTF guidelines centers on screening only women who were considered high risk before age 50.

“To suggest screening can be based on risk alone is a pie in the sky argument,” Kopans said.

He added that the vast majority of women diagnosed with breast cancer each year were not in high risk groups.

“The data clearly supports annual mammography for all women,” he said. “All of the major organizations show that the most lives are saved by annual mammography starting at age 40.”