Making sense of the new guidelines for screening mammograms
Confused by recent news about mammogram recommendations?
Here is where four national health organizations stand on mammography for women at average risk for breast cancer. Women with certain risk factors, such as family history, should speak with their doctor about when to get screening mammograms.
It’s easy to see why these recommendations can be confusing. If key health organizations seem unable to agree, the natural question from many women might be, “What do these recommendations really mean for me?”
Natalie Stephens, M.D., medical director of the Norton Cancer Institute Breast Health Program, answers questions you may have.
Q: Why is there ongoing debate about when women should start and end mammogram screenings?
A: By their nature, science and medicine are ever-changing. As research produces new information, it’s not unusual for scientists to come to different conclusions about the same data. Over time, as results are assessed, recommended processes and procedures are updated to balance potential benefits against potential risks and provide the best outcomes possible.
Q: What are the risks of getting a mammogram even if it’s not recommended?
A: False positives can cause undue worry, pain and testing or procedures, such as biopsies. Mammograms require very small doses of radiation, so the risk of exposure is quite low, yet it bears mentioning that repeated X-rays have the potential to cause cancer. The benefits of mammography, however, almost always outweigh the potential harm from radiation exposure.
Q: Do the guidelines affect whether my insurance will pay for a mammogram based on my age?
A: The guidelines don’t make specific recommendations about reimbursement. Generally, little impact in coverage was seen after the U.S. Preventive Services Task Force issued its recommended screening changes in 2009. The Patient Protection and Affordable Care Act mandates that mammograms are covered with no co-pay or deductible for plans started after Aug. 1, 2012, however this doesn’t apply to “grandfathered” health plans in place before the law was passed. When in doubt, it’s best to check directly with your provider to clarify what your plan will cover.
Q. Even if it’s not recommended, if I decide I want a mammogram, can I get one?
A. The guidelines provide a framework for women at average risk, yet they leave room for personal decisions and choices. Women who want to be screened, regardless of age or risk, should discuss family and medical history, personal values and preferences, and potential benefits and harms with their physician or other health care professional. Women who decide they need to be screened should definitely be screened.
Ultimately, despite any ongoing debate about the screening guidelines, we know two things: Breast cancer is a leading cause of premature death among women in the United States. Early detection has been shown to help reduce cancer death rates. Anything that helps provide effective guidance and flexibility for women about when to start and stop getting screening mammograms is well worth the debate.