Don’t forget, though, that the varying recommendations also impact whether insurance will cover annual mammograms under age 50. While the frequency and timing of preventive screening should be a discussion and shared plan of care between a patient (all biological women, regardless of current gender identity) and their medical team. But few patients will follow a regimen if their insurance plan doesn’t cover the screening and the out of pocket cost is hundreds or thousands of dollars.
When academic and specialty societies agree on a standard of care, they are more successful in advocating for coverage of that standard by all insurance plans thus reducing health disparities.
Came here to make the same comment. I am fully employed and have health insurance, but my first ACA covered screening mammogram lead to a diagnostic mammogram and ultrasound that cost close to $1000. I did not go back for another diagnostic mammogram six months later because of the cost of the first one.
I currently have several friends (between 45-70 yo) who have breast cancer. Two had clear mammograms one year and cancer the next (resulting in surgery for both, radiation and chemo for one). A third opted for treatment upon discovery of a stage 0 breast cancer. One mentioned that she had not been getting the 3D mammogram, and that this might have been the reason for a delayed detection (she had 5 tumors in one breast). Apparently her insurance charged $50 for the 3D mammogram, whereas it's covered annually in my plan. We all have dense breast tissue. Once, I was called back for a follow up sonogram after the mammogram yielded inconclusive results. A couple of other times I was called back for a follow up mammogram. My hope is that screening improves, in particular for populations for whom mammograms aren't great at early detection. It's essential that access to screening be consistently and affordably priced across health insurance plans, too.
Please reconsider the use of the term "assigned at birth". You are scientists, and should not use terms based on mystical beliefs. The Cass review has demonstrated the extent to which the medical profession has been captured by ideology. It is not good for patients, and it also adds, justifiably, to the erosion of faith in science. If we want people to believe medical experts, they need to be scientific, even when it goes against their ideologies. Virginia Dale, MD
Counterpoint: "assigned (fe)male at birth" is not inaccurate, because we still do choose male or female at birth depending on what's visible. It's the most respectful of people who do share the ideology I think you mean, but because it's true, it's not DISrespectful to anyone. Public health wants to reach the most number of people possible in the way that will lead to the most action, so using the most inclusive terminology makes sense to me, regardless of how I feel about "gender-affirming care."
Also it is the criterion that was chosen by the authors of the linked JAMA article. ("Cisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer.") Critiquing their criterion seems reasonable, but using other language would make this article less accurate.
"Women" is a perfectly valid and clearly defined scientific term, up until a bunch of religious cultists attempted to change it's meaning. The vast majority of the public has not kept up with the cult's language, and so using it is contrary to the goals of public health.
After 75 the official guideline is “decide individually with your doctor if continuing screening is needed.” There are many women at 75+ who should continue because their life expectancy is long. They are some where it is not worth it. But they did not want a blanket recommendation at that age.
I was diagnosed with breast cancer ten days after a “normal” mammogram giving me notice I had no problems with my breasts. It was three days after the notice arrived that I found a lump. My mammogram was the ‘new’ 3 D. I have very dense breast tissue, which has been known since I was 18. I was 64 when diagnosed. Mammograms do not find all tumors. Mine was almost two centimeters, not small. It should be part of the mammogram for any woman who has dense breast tissue to have an ultrasound. That should be the minimum standard, if we really want to address appropriate healthcare for women. I am now 70, and am also a retired registered nurse. One size does not fit all for mammograms.
There are recommendations and guidelines, and then there are the de facto realities of practicing medicine. Most doctors will start to recommend screening at 40 yo with yearly mammograms, because to do otherwise and miss a breast cancer can result in a massive lawsuit. The guidelines offer a layer of protection, but a jury of laypeople is under no real obligation to apply them in reaching their verdict. Your verdict, which can be ruinous.
That being said most doctors work under the imperative to catch things early because we generally love and respect our patients, so the trade offs between harms and benefits with any screening become harder to objectify when you genuinely want to help.
An effective vaccine would be amazing, with progress already happening for melanoma treatment among others. Will stay tuned, thanks!
I am really thankful to be seen in a breast center. So, I get a mammogram and then have an appointment immediately after with a NP to discuss results. No waiting for a letter. I also had genetic testing last month. I am 43, had my first mammo at 38, and have dense breasts. My maternal grandmother had breast cancer. My mother died during my birth. My care team is proactive, and I am so grateful.
I have had to return for a second mammogram too many times. So now I ask for (when I make the appointment)/receive an immediate reading so that if they need that second picture I’m already there. I usually have to wait only 15-20ish minutes, because they know in advance. For me, it’s less stress, and less hassle.
Any thoughts about dense breasts and the suggestion one gets an MRI (at 77)— the concern is the dye used to highlight it — the dye stays in some of your organs and brain for months on end with varying degrees of side effects. I’m trying to weigh which is worse…
I am 75 years old. I had breast cancer at age 38. I was very lucky that it was found. (It’s a long story) It was small. Less than 1cm. But they had just started testing for estrogen receptors and it was estrogen negative. Most likely it was a triple negative cancer. I opted for a modified radical mastectomy and it was followed by six months of chemotherapy. Cytoxan, Methotrexate and 5FU. A year later I had the other breast removed prophalactically with a simple mastectomy. I am grateful every day that I am still here. 37 years… Please get your mammograms starting at age 40. I am happy to tell my whole story if anyone is interested.
I really like that you covered this issue. Like one of the commenters above, I would like to have more information on Breast MRIs. I have dense breasts and my mother died of breast cancer before menopause. I had genetic testing recently and have no genetic factor that is know. There is some suggestion that I should have a Breast MRI but I am claustrophobic and just the idea of doing it keeps me up at night.
Also, the Karmanos Center in Detroit is using Softvue Ultrasounds which use warm water and ultrasound technology to create a 3D image for dense breasts. Is that technique any better than 3D mammograms for dense breasts?
I’ll admit to being confused by the guidelines, primarily because the very millisecond I turned 40, everyone from my doctors to my Facebook ads screamed at me to get my mammogram. I had a freaking urgent care offer to schedule a mammogram for me. I had to tell everyone to back off for months because I wanted it timed to my gyno annual for tracking purposes. Even after I got it, everyone talked like it was going to happen again the next year, and I’m pretty sure they hadn’t checked with my insurance on that one. I’ve had enough issues with insurance and USPTF guidelines to know that I can’t even believe them if I call ahead to check if it is covered. I can’t imagine what would happen financially to someone who wasn’t used to wrangling insurance.
Please explain the rationale for stopping screening at age 74. Are there data to show that rates of new onset breast cancers go down after that age? Is this guideline based on life expectancy? Life expectancy for a woman who makes it to age 74 is about 21 more years. Does it not matter what happens to her during those 21 more years?
Thank you for your very thoughtful explanation of these recommended changes for screening. It’s also great to learn of some positive outcomes from the use of AI.
Reading x-rays, MRIs, etc. is one of the BEST uses of AI! It's tedious and repetitive and we have a TON of data to train it with, because most people who get cancer have multiple previous scans. That's not to say we should put all radiologists out of a job, but using AI as the first level screener to draw people's attention to things would be a huge win, and relatively cheap after the first training.
I am an epidemiologist who worked on cancer screening guidelines for a large healthcare system in the US. My issue is about the rationale supporting ages to stop screening. Many people who don’t understand cancer risk feel that at a certain age, they are no longer at risk, so they go along with the schedule. We all know that cancer risk increases with age. One of the arguments from the medical community is that you are more likely to die of something else (at the age that it would take a cancer to kill you after discontinuing screening) than of the cancer. And the other argument is ‘over diagnosis’, with the rationale that following up on positive screening tests that may not become cancers are more harmful than the risk of getting cancer at an older age. For most cancers we have no valid way of identifying those who are likely to get an aggressive cancer. And given that many women (in the case of breast cancer screening) will live much longer than 84 years (10 years after screening is discontinued, which is an estimate of how long it would take an untreated cancer to run it’s course and kill a person), is it ethical to make a blanket statement about ages to stop screening? Also, what is the cost to the healthcare system for treating these cancers at an advanced stage? As far as I know, it’s not ethical to refuse treatment at any age, especially if the patient is otherwise healthy. Katelyn, I would be very interested in your thoughts.
Don’t forget, though, that the varying recommendations also impact whether insurance will cover annual mammograms under age 50. While the frequency and timing of preventive screening should be a discussion and shared plan of care between a patient (all biological women, regardless of current gender identity) and their medical team. But few patients will follow a regimen if their insurance plan doesn’t cover the screening and the out of pocket cost is hundreds or thousands of dollars.
When academic and specialty societies agree on a standard of care, they are more successful in advocating for coverage of that standard by all insurance plans thus reducing health disparities.
I updated the post to include mention of this critical implication. Thank you for keeping the conversation on target!
This is a super important point!
Came here to make the same comment. I am fully employed and have health insurance, but my first ACA covered screening mammogram lead to a diagnostic mammogram and ultrasound that cost close to $1000. I did not go back for another diagnostic mammogram six months later because of the cost of the first one.
I currently have several friends (between 45-70 yo) who have breast cancer. Two had clear mammograms one year and cancer the next (resulting in surgery for both, radiation and chemo for one). A third opted for treatment upon discovery of a stage 0 breast cancer. One mentioned that she had not been getting the 3D mammogram, and that this might have been the reason for a delayed detection (she had 5 tumors in one breast). Apparently her insurance charged $50 for the 3D mammogram, whereas it's covered annually in my plan. We all have dense breast tissue. Once, I was called back for a follow up sonogram after the mammogram yielded inconclusive results. A couple of other times I was called back for a follow up mammogram. My hope is that screening improves, in particular for populations for whom mammograms aren't great at early detection. It's essential that access to screening be consistently and affordably priced across health insurance plans, too.
Please reconsider the use of the term "assigned at birth". You are scientists, and should not use terms based on mystical beliefs. The Cass review has demonstrated the extent to which the medical profession has been captured by ideology. It is not good for patients, and it also adds, justifiably, to the erosion of faith in science. If we want people to believe medical experts, they need to be scientific, even when it goes against their ideologies. Virginia Dale, MD
Counterpoint: "assigned (fe)male at birth" is not inaccurate, because we still do choose male or female at birth depending on what's visible. It's the most respectful of people who do share the ideology I think you mean, but because it's true, it's not DISrespectful to anyone. Public health wants to reach the most number of people possible in the way that will lead to the most action, so using the most inclusive terminology makes sense to me, regardless of how I feel about "gender-affirming care."
Also it is the criterion that was chosen by the authors of the linked JAMA article. ("Cisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer.") Critiquing their criterion seems reasonable, but using other language would make this article less accurate.
Yes. The use of that phrase always makes me wonder “who” assigned it and which definition of “assigned” is implied.
What is the “scientific” term you suggest instead, which would accurately capture all individuals to whom this guidance applies?
Women.
"Women" is a perfectly valid and clearly defined scientific term, up until a bunch of religious cultists attempted to change it's meaning. The vast majority of the public has not kept up with the cult's language, and so using it is contrary to the goals of public health.
Please discuss that upper limit of 74. Women still get breast cancer after 74! Have they just decided we are old enough to die?
After 75 the official guideline is “decide individually with your doctor if continuing screening is needed.” There are many women at 75+ who should continue because their life expectancy is long. They are some where it is not worth it. But they did not want a blanket recommendation at that age.
My question also. I will be 78 in October and I plan to get a 3D mammogram this summer. Medicare has been paying every year….so far.
I was diagnosed with breast cancer ten days after a “normal” mammogram giving me notice I had no problems with my breasts. It was three days after the notice arrived that I found a lump. My mammogram was the ‘new’ 3 D. I have very dense breast tissue, which has been known since I was 18. I was 64 when diagnosed. Mammograms do not find all tumors. Mine was almost two centimeters, not small. It should be part of the mammogram for any woman who has dense breast tissue to have an ultrasound. That should be the minimum standard, if we really want to address appropriate healthcare for women. I am now 70, and am also a retired registered nurse. One size does not fit all for mammograms.
There are recommendations and guidelines, and then there are the de facto realities of practicing medicine. Most doctors will start to recommend screening at 40 yo with yearly mammograms, because to do otherwise and miss a breast cancer can result in a massive lawsuit. The guidelines offer a layer of protection, but a jury of laypeople is under no real obligation to apply them in reaching their verdict. Your verdict, which can be ruinous.
That being said most doctors work under the imperative to catch things early because we generally love and respect our patients, so the trade offs between harms and benefits with any screening become harder to objectify when you genuinely want to help.
An effective vaccine would be amazing, with progress already happening for melanoma treatment among others. Will stay tuned, thanks!
I am really thankful to be seen in a breast center. So, I get a mammogram and then have an appointment immediately after with a NP to discuss results. No waiting for a letter. I also had genetic testing last month. I am 43, had my first mammo at 38, and have dense breasts. My maternal grandmother had breast cancer. My mother died during my birth. My care team is proactive, and I am so grateful.
I have had to return for a second mammogram too many times. So now I ask for (when I make the appointment)/receive an immediate reading so that if they need that second picture I’m already there. I usually have to wait only 15-20ish minutes, because they know in advance. For me, it’s less stress, and less hassle.
Any thoughts about dense breasts and the suggestion one gets an MRI (at 77)— the concern is the dye used to highlight it — the dye stays in some of your organs and brain for months on end with varying degrees of side effects. I’m trying to weigh which is worse…
I am 75 years old. I had breast cancer at age 38. I was very lucky that it was found. (It’s a long story) It was small. Less than 1cm. But they had just started testing for estrogen receptors and it was estrogen negative. Most likely it was a triple negative cancer. I opted for a modified radical mastectomy and it was followed by six months of chemotherapy. Cytoxan, Methotrexate and 5FU. A year later I had the other breast removed prophalactically with a simple mastectomy. I am grateful every day that I am still here. 37 years… Please get your mammograms starting at age 40. I am happy to tell my whole story if anyone is interested.
I really like that you covered this issue. Like one of the commenters above, I would like to have more information on Breast MRIs. I have dense breasts and my mother died of breast cancer before menopause. I had genetic testing recently and have no genetic factor that is know. There is some suggestion that I should have a Breast MRI but I am claustrophobic and just the idea of doing it keeps me up at night.
Also, the Karmanos Center in Detroit is using Softvue Ultrasounds which use warm water and ultrasound technology to create a 3D image for dense breasts. Is that technique any better than 3D mammograms for dense breasts?
Thank you for all that you are doing!
I sure wouldn't mind doing something besides squishing my boobs! 😆
"assigned female at birth"???
Please stop with this nonsense, Katelyn. It is destructive of the truth in medicine, and contrary to what I thought you stood for.
I’ll admit to being confused by the guidelines, primarily because the very millisecond I turned 40, everyone from my doctors to my Facebook ads screamed at me to get my mammogram. I had a freaking urgent care offer to schedule a mammogram for me. I had to tell everyone to back off for months because I wanted it timed to my gyno annual for tracking purposes. Even after I got it, everyone talked like it was going to happen again the next year, and I’m pretty sure they hadn’t checked with my insurance on that one. I’ve had enough issues with insurance and USPTF guidelines to know that I can’t even believe them if I call ahead to check if it is covered. I can’t imagine what would happen financially to someone who wasn’t used to wrangling insurance.
The graph of breast cancer incidence seems odd. Are there any theories what caused the change in 2017-19?
Maybe the thousands of untested chemicals in the environment? Frogs aren't too happy... just a thought.
Please explain the rationale for stopping screening at age 74. Are there data to show that rates of new onset breast cancers go down after that age? Is this guideline based on life expectancy? Life expectancy for a woman who makes it to age 74 is about 21 more years. Does it not matter what happens to her during those 21 more years?
Thank you for your very thoughtful explanation of these recommended changes for screening. It’s also great to learn of some positive outcomes from the use of AI.
Reading x-rays, MRIs, etc. is one of the BEST uses of AI! It's tedious and repetitive and we have a TON of data to train it with, because most people who get cancer have multiple previous scans. That's not to say we should put all radiologists out of a job, but using AI as the first level screener to draw people's attention to things would be a huge win, and relatively cheap after the first training.
Thank you for the further clarification about useful AI is for reviewing scans.
I am an epidemiologist who worked on cancer screening guidelines for a large healthcare system in the US. My issue is about the rationale supporting ages to stop screening. Many people who don’t understand cancer risk feel that at a certain age, they are no longer at risk, so they go along with the schedule. We all know that cancer risk increases with age. One of the arguments from the medical community is that you are more likely to die of something else (at the age that it would take a cancer to kill you after discontinuing screening) than of the cancer. And the other argument is ‘over diagnosis’, with the rationale that following up on positive screening tests that may not become cancers are more harmful than the risk of getting cancer at an older age. For most cancers we have no valid way of identifying those who are likely to get an aggressive cancer. And given that many women (in the case of breast cancer screening) will live much longer than 84 years (10 years after screening is discontinued, which is an estimate of how long it would take an untreated cancer to run it’s course and kill a person), is it ethical to make a blanket statement about ages to stop screening? Also, what is the cost to the healthcare system for treating these cancers at an advanced stage? As far as I know, it’s not ethical to refuse treatment at any age, especially if the patient is otherwise healthy. Katelyn, I would be very interested in your thoughts.