How Can We Address Overdiagnosis of Breast Cancer with More Caution and Diligence?

Screening exams for cancer are always debated in the medical community for their usefulness. Breast cancer screening tests are no different. There is and probably always be debate about what to do and when to do it.

There is no debate about the value of mammograms. They are important. Today the recommendations are as follows:

1. U.S. Preventive Services Task Force (USPSTF)

• Age 50-74: Recommends biennial (every two years) mammography for women in this age group.

• Age 40-49: Individual decision-making is recommended. Women should discuss with their healthcare provider to weigh the benefits and risks before starting routine screening.

• Age 75 and Older: No specific recommendation due to insufficient evidence, though many clinicians suggest continuing screening based on individual health status.

  
  

2. American Cancer Society (ACS)

• Age 45-54: Recommends annual mammograms for women in this age group.

• Age 40-44: Women should have the option to start annual screening if they choose.

• Age 55 and Older: Can transition to biennial screening or continue annual screening based on personal preference.

• Continue as Long as Health is Good: Screening should continue as long as a woman is in good health and has a life expectancy of 10 years or more.

  
  

3. American College of Radiology (ACR) and Society of Breast Imaging (SBI)

• Age 40 and Older: Recommends annual mammograms starting at age 40 and continuing as long as a woman is in good health.

• High-Risk Women: Women at higher risk (e.g., those with a family history of breast cancer) should start screening earlier, often at age 30, and may require additional imaging like MRI.

  
  

4. World Health Organization (WHO)

• Age 50-69: Recommends biennial mammography screening as the most effective strategy for reducing breast cancer mortality.

• Age 40-49: Emphasizes the importance of considering individual risk factors and potential harms, with screening decisions made on a case-by-case basis.

  
  

5. National Comprehensive Cancer Network (NCCN)

• Age 40 and Older: Recommends annual mammograms for average-risk women.

• High-Risk Women: Similar to ACR, they suggest starting screening at a younger age with more frequent imaging.

Although the importance of mammograms is not in question, one must consider many factors for the best and safest care for individual patients. This fact is highlighted by the following information.

A Study Published in the New England Journal of Medicine (2012) estimated that over three decades, more than 1.3 million women in the United States were potentially overdiagnosed with breast cancer due to screening mammography. The study was entitled, "Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence".

This study was conducted by Dr. Archie Bleyer and Dr. H. Gilbert Welch. They analyzed the impact of mammography screening on breast cancer diagnosis and suggested that over three decades, as many as 1.3 million women in the United States might have been overdiagnosed with breast cancer. This means that these women were diagnosed with cancers that would not have caused symptoms or death if left untreated​Various studies have estimated different figures, but the consensus in the medical community is that overdiagnosis is a real and significant issue.

A 2023 study ("Estimating Breast Cancer Overdiagnosis After Screening Mammography Among Older Women in the United States.") found that a considerable percentage of breast cancer cases identified through screening in women aged 70 and older might have been overdiagnosed, meaning the cancers detected would not have caused symptoms or affected the women during their lifetimes. This study was published in the journal Annals of Internal Medicine.

The study, which analyzed data from over 54,000 women, estimated that 31% of breast cancer cases in women aged 70 to 74 were potentially overdiagnosed. This percentage increased with age, with 47% in women aged 75 to 84, and 54% in those 85 and older. The study also noted that the risk of overdiagnosis was higher among women with shorter life expectancies​.

There are multiple modalities used today to diagnose/assess breast cancer:

1. Breast Self Exam

2. Mammogram (Digital and 3D)

3. Ultrasound

4. Targeted Breast MRI

5. Molecular Breast Imaging

6. Breast Biopsy

7. Positron Emission Tomography (PET) Scan

8. Thermography

9. Genetic Testing (BRCA1 and BRCA2)

In light of the current research on overdiagnosis and unnecessary treatment, all available modalities must be appropriately used to assess for and diagnose breast cancer accurately so women are not unduly/unnecessarily traumatized, or treated.