Benefits outweigh costs of mammograms

I am writing in response to the U.S. Preventive Services Task Force recommendations regarding screening for breast cancer. They suggest no screening age 40-49 and at most biennial screening 50-59 and nothing after 75.

These recommendations ignore decades of strong evidence showing the most important benefit to screening mammography, reduction in mortality. In their own article they cite an annual 3.3 percent steady decline in mortality from breast cancer since 1990 and they attribute this decline to mammography. They focus their argument against screening with the "harms" caused by mammography. What they do not mention is that mammography is the only test that has proved to be effective in early detection. They are therefore siding with late detection. The harms of late detection are much more concrete and in my opinion represent real harm. They include all the harms associated with advanced breast cancer like chemotherapy, radiation, metastasis and death.

They say that the benefits to screening women 40-49 are "small." Small is a relative term and is better understood with some perspective. At Northwest Community Hospital we run a moderate-sized screening program.

In 2008 we found 105 cancers in the 40-49 age group by mammography only, this represents a third of the cancers that were treated at our institution. In my opinion, this is not a small number.

Lastly, it seems bizarre to ration screening in the age group that has the most to benefit as far as years of life lost. Women in this group often still have children in school and are in the prime of their working lives. It is true that in order to find cancer in any group that many women will have extra breast ultrasounds and biopsies. This can cause worry and some physical discomfort, these pale when compared to detecting cancer when it is advanced.

Dr. Allan Malmed

Director, Northwest Community Hospital Breast Program

Arlington Heights