Mammogram guideline sparks debate among breast cancer experts

Health experts agree that mammograms can save lives, but they don’t always agree on how often women should get the breast cancer screening procedure or when they should start.

The U.S. Preventive Services Task Force, an influential panel of national experts, drew praise from advocates when it recently dropped the recommended age for most women to get mammograms to 40 from 50. But it also advised mammograms every other year instead of annually — a move that left some doctors frustrated and many patients confused.

The American Cancer Society, for example, recommends women have the option of starting annual screenings at age 40 but says they should start receiving annual mammograms at 45. 

“It’s creating a huge amount of confusion among my patients and the practicing primary care physicians sending patients to me,” said Dr. Cindy Lee, chief of breast imaging at Stony Brook Medicine.

In its recommendation, the task force said evidence showed biennial screening was a better option to balance the detection of cancers with the possible harms of false positives. Annual screenings, it pointed out, could lead to more false-positive diagnoses, possibly causing unnecessary procedures.

Sometimes a mammogram might reveal a spot or mass, prompting the need for an ultrasound, MRI or biopsy to determine whether it is benign or cancerous. When it is benign, it is considered a false positive. Studies have shown that false positives can increase the stress level for patients and even make them less likely to return for regular mammograms.

But Long Island doctors said it's better for patients to have the knowledge there might be something in their breast, and then they can discuss options with their doctors.

Dr. Alfredo Torres, an oncologist at NY Cancer and Blood Specialists in Port Jefferson, said he always recommends annual mammograms for women at average risk who are 40 and older.

“We are seeing younger and younger patients getting breast cancer so I am not going to change from 40 and every year,” said Torres, who is also an American Cancer Society Long Island board member.

Lee said she believes the more mammograms that are performed, the more lives can be saved and noted that the possibility of a false positive result should not dissuade women.

“I don’t like to compare genders, but prostate cancer screening is notoriously full of false positives,” she said. “You don’t hear complaints about men being anxious or them wanting to cut back.”

Higher LI breast cancer rates

Breast cancer is the second-most common cancer among women in the United States, according to the Centers for Disease Control and Prevention, topped only by some types of skin cancer.

More than 43,100 women died of breast cancer in 2023, according to estimates quoted by the task force. Black women are more likely to be diagnosed with later stage breast cancer and about 40% more likely to die of breast cancer when compared with white women. The highest rates of breast cancer cases overall are among non-Hispanic white women, followed by non-Hispanic Black women.

Female breast cancer rates vary around the region, with Long Island's higher than New York City and the state.

The Nassau County rate of breast cancer is 145.9 per 100,000 and Suffolk County is 139.9, according to the New York State Cancer Registry. New York City's rate is 126.1 and the state's rate is 134 per 100,000.

Mammograms — an X-ray image of the breast — are a game changer in efforts to catch these cancers early and treat them. One study reported that women who had mammograms had a 41% reduction in their risk of dying of breast cancer within 10 years and a 25% reduction in the rate of advanced breast cancers.

But there remains a debate over how often they should be given to women at average risk. The guidelines are different for women at higher risk — those with a family history of breast cancer, who test positive for genes linked to breast cancer or who had previous radiation on their chest.

The guidelines are a framework for patients to use when discussing mammograms with their doctors, said Dr. Melissa Fana, a breast surgical oncologist and NYU Langone Health’s director of women’s health for Suffolk County.

“For a woman who is truly at average risk, the determination of whether it’s every year or every two is really made in conjunction with their health care provider,” she said.

Fana said she is encouraged the task force guidelines dropped the age women should start mammograms. But she said it's key that every woman knows her lifetime risk, which includes factors ranging from age at first menstrual period to whether or not they have given birth, family history and race/ethnicity.

“I’m just afraid we will miss people,” if women only go every other year for a mammogram, said Dr. Monique De Four Jones, associate chief of labor and delivery at Katz Women’s Hospital — Long Island Jewish Medical Center in New Hyde Park. “Some people don’t like going to doctors to begin with.”

De Four Jones said going every two years can be further delayed if the women are too busy, centers are not accessible and the patient does not have insurance.

Dr. Sophia Fu, director of breast surgery at Good Samaritan University Hospital in West Islip, said having annual mammograms makes a difference.

“The reason we have done so well in the treatment of breast cancer is that we are always trying to get ahead of the curve,” she said. “There are cancers that can grow sooner than two years.”

Fana said women need to prioritize their health care and know their family history and personal risk assessment for breast cancer. Those at higher risk can get screened earlier than age 40.

“You wouldn't miss a mortgage payment,” Fana said. “You should not miss a mammogram.”

By Lisa L. Colangelo

lisa.colangelo@newsday.com@lisalcolangelo

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.