Mammography debate: Who should get screened and when?

Experts revisit questions of whether the benefits outweigh the risks and wonder if women fully understand what they are undertaking.

By Victoria Stagg Elliott, AMNews staff. Nov. 10, 2003.

Consider these scenarios.

An angry and frightened 37-year-old woman demanded that Alfred O. Berg, MD, MPH, go to bat for her so her insurer would pay for a mammogram, even though screening guidelines suggest that women not have the test until they're at least 40.

Another female patient, a 53-year-old, declined the test, despite strong evidence suggesting that it would be a good idea. Her insurance did not cover it and she decided she would benefit more from paying her heating bill.

"Both decisions are correct," said Dr. Berg, who chairs the department of family medicine at the University of Washington, Seattle, and also is chair of the U.S. Preventive Services Task Force. "But it just shows you how if you look at the science you'd say they were probably not making the best choices."

Both situations illustrate the difficult position in which many physicians find themselves regarding mammography. Evidence strongly supports annual screening for women in their 50s and 60s, but is less conclusive for women in their 40s. Some medical specialty societies do recommend it. And, the preventive task force classifies the data in support of it as "fair."

"This remains a contentious issue -- mammographic screening in whom, at what age, and how frequently," said Susan Hendrix, DO, associate professor of obstetrics and gynecology at Wayne State University School of Medicine in Detroit.

It is the discussion about those on the younger end of the age spectrum that causes the most uncertainty.