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Margaret I. Cuomo, M.D. Headshot

Mammography: A Limited Tool for Early Detection of Breast Cancer

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Mammography has been the gold standard for early detection of breast cancer since the 1970s but has been surrounded by controversy more recently. In 2009, the United States Preventive Services Task Force (USPSTF) recommended that routine screening mammography begin at age 50, and that screening should be optional for younger women. Mammograms performed every two years, rather than annually, was advised for women of average risk of breast cancer.

The American Cancer Society, American College of Radiology, and others opposed the USPTF recommendations and supported annual mammograms and also advised annual mammography for women younger than 50.

This week, a study in Cancer by Blake Cady, M.D., of Massachusetts General Hospital in Boston, and co-authors reported that annual mammography has a definite survival benefit for young and older women:

Regular screening increases the likelihood of detecting nonpalpable cancers (cancers that cannot be detected by physical examination), and annual screening further increases the likelihood relative to biennial screening.

These authors also analyzed breast cancer and non-breast cancer deaths by age and discovered that half of all breast cancer deaths occurred in women younger than age 50, and 69 percent before age 60.

What Dr. Cady and his colleagues are not examining is the effect on cancer risk due to the radiation exposure of annual mammograms beginning at a young age.

Other scientific studies have reported on the radiation risk from screening mammography in women younger than age 50, especially among women with a family history of breast cancer, or a genetic predisposition. [1] While these studies have admitted a risk of cancer due to annual mammograms, the public's perception is that the risk is small compared with the benefit in saving women's lives. [2] [3]

We can all agree that mammography is a limited screening tool at best. It is time to engage in an intensive, focused research effort to discover the specific biomarkers that will assess a women's breast cancer risk and identify those patients most likely to benefit from a specific molecularly-targeted therapy. A non-invasive test that is sensitive and specific for the early detection of breast cancer is a goal worthy of our investment and dedication.

Mammography will remain a controversial issue because it is an imperfect tool involving ionizing radiation. Let's move beyond this method that is decades old and move forward with an early detection method for breast cancer that will not increase a women's cancer risk at all. The National Cancer Institute, American Cancer Society and research institutions across the U.S. could join in a collaborative effort to achieve this goal so that our daughters and granddaughters will have a safer, more intelligent approach to breast cancer screening.


[1] Jansen-van der Weide MC, Greuter MJ, Jansen L, Oosterwijk JC, Pijnappel RM, de Bock GH, 2010, Exposure to low-dose radiation and the risk of breast cancer among women with a familial or genetic predisposition: a meta-analysis, Eur Radiol. 2010 Nov;20(11):2547-56. doi: 10.1007/s00330-010-1839-y

[2] J Natl Cancer Inst Monogr. (1997) 1997 (22): 119-124. Feig, Stephen, and Hendrick, R. Edward, Radiation Risk of Screening Mammography of Women Aged 40-49 Years

[3] January 2011 Radiology, 258, 98-105. Yaffe, Martin, and Mainprize, James, Risk of Radiation-induced Breast Cancer from Mammographic Screening.

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