It's too risky to wait for breast cancer screening

A government task force is now recommending that women under the age of 50 no longer obtain routine mammograms – the most reliable screening tool we have for detecting breast cancer. This is at odds with previous guidelines, which once suggested that women age 40 and older should have regular mammograms.

This change of tune from the U.S. Preventive Services Task Force is in response to research that has shown how mammograms provide little benefit to low-risk women under the age of 50. The task force also expressed concern about the increased anxiety involved with screening younger women, the increased stress when a mammogram wrongly identifies a possible cancer, and the subsequent procedures needed to refute the diagnosis of cancer.

Yes, it is true that mammograms are less reliable in diagnosing cancers in younger breasts. The denser tissue can make cancers harder to see. However, it is irresponsible to remove a screening tool from this age group without providing another mechanism of screening, especially for African-American women.

The recommendations fail to address the fact that breast cancer does occur significantly among young women. About 10 percent of all women with breast cancer are under the age of 45. In addition, younger women often have more aggressive breast cancers and higher rates of mortality from breast cancer than older women. This is not a population that we can afford to ignore until age 50.

The statistics for young African-American women are even worse. Research shows that African-American women under the age of 45 have a disproportionately high mortality from breast cancer than other women, partly as a result of having their cancer detected at a later stage. A 2008 study also found that while deaths from breast cancer are decreasing for women of other races across all states, that is not the case for black women.

Monthly self-breast exams have already come under fire by some physicians, who claim that such exams lead to a large number of unnecessary biopsies, which leave women with scar tissue that gets in the way of mammograms later on. Authors of a 2008 study, along with other physicians, have surprisingly suggested that women avoid performing self-breast exams altogether. The task force agrees with this suggestion.

So, if we don’t have breast exams and we don’t have mammograms, how will a woman under 50 know that a potentially fatal cancer is developing in her breast? The task force’s recommendations fail to answer this question.

Thankfully, major organizations such as the American Cancer Society, the American College of Radiology and the American College of Obstetrics and Gynecology have criticized the new guidelines. Some physicians say they will continue to advise mammograms for their patients over 40. However, there is speculation that insurance companies may stop reimbursing for mammograms under the age of 50 in light of the task force’s recommendations.

This is a major concern for African-American women who have historically had problems gaining access to mammograms. This creates yet another barrier for these women in obtaining the much-needed screening test, the lack of which is already contributing to unnecessary deaths of African-American women from breast cancer.