mammography wars Archives - The Imaging Wire

A new study confirms that not only does breast cancer screening save lives, but it also improves survival in women with late-stage disease. Researchers found that women with stage IV breast cancer had a survival rate over three times higher if their disease was detected with screening, thanks largely to its role in driving treatment.

The “Mammography Wars” over breast cancer screening’s effectiveness raged from the 1980s to the 2010s, but eventually were decided in mammography’s favor.

Multiple research studies have demonstrated that the combination of early detection and more effective treatments improve breast cancer survival. The USPSTF’s 2023 shift back to recommending that screening start at 40 settled the issue.

But pockets of anti-screening resistance remain, with screening skeptics publishing several studies since the USPSTF change questioning the value not only of mammography but also other cancer screening tests.

So it’s more important than ever to demonstrate cancer screening’s value.

The new study in the Journal of the National Cancer Institute does just that by analyzing screening’s impact on survival rates in women diagnosed with stage IV disease who had been invited to Denmark’s national breast screening program (not all women completed mammography despite getting invited).

In all, 32.8k women with breast cancer were included, of whom 8% presented with stage III or stage IV cancer.

The researchers found that for women with stage IV breast cancer…

Five-year survival was over 2X higher for women with screen-detected cancer versus women who were never screened (75% vs. 32%).
Ten-year survival was over 3X higher (62% vs. 17%).
Women with later-stage disease detected by screening had survival rates over five years comparable to women with disease one stage lower who were never screened.
Survival rates were strongly influenced by treatment type, with surgical treatment showing the longest median survival versus non-surgical treatment and no treatment (6, 2, and 0.1 years, respectively).

The big difference in survival was driven by the fact that women with screen-detected cancers were far more likely to get surgical treatment, and to subsequently have better 10-year survival rates than those treated without surgery (60% vs. 8%).

The Takeaway

The new study once again proves the value of screening mammography, but it goes beyond just showing that screening causes a stage shift to earlier diagnosis. Even in women with late-stage disease, screening is driving more effective treatment that is proving invaluable in saving women’s lives.

A new study on mammography screening confirms the worst fears of women’s health advocates: screening rates fell for women ages 40-49 after the USPSTF in 2009 withdrew its recommendation that younger women get biennial screening.

Breast screening has long been the most controversial cancer screening exam, with screening’s opponents claiming that its “harms” – such as breast biopsies and overdiagnosis – don’t justify its benefits.

The anti-mammography wave crested in 2009 when the USPSTF withdrew its screening recommendation for women ages 40-49 and older than 75, instead advising them to consult with their physicians.

The change prompted confusion and anger that persisted until the task force in 2024 rescinded the 2009 guidance and returned to a broad recommendation in favor of biennial screening for women in their 40s (screening still isn’t recommended for women over 74).

This left the breast imaging community pondering the impact that 15 years of the more restrictive guidance had on breast screening rates.

Researchers address that question in a new study in JAMA Network Open, in which they analyzed screening records for 1.6M women, finding the probability of getting a biennial mammogram …

Fell -1.1 percentage points for all women ages 40-49.
Fell -3 percentage points for non-Hispanic Black women 40-49, the biggest decline among younger women.
Fell -4.8 percentage points for all women 75 years and older.
Fell -6.2 percentage points for Hispanic women over age 75, the biggest decline among all age groups.

The new research confirms other studies finding that the USPSTF 2009 guidance led to a small – but statistically significant – decline in overall breast screening rates.

What’s new is its discovery of demographic variations in the magnitude of the change, an important finding given recent studies showing that Black women have a 39% higher breast cancer mortality rate.

In fact, rising cancer risk in Black women was cited by the USPSTF as one of its reasons for changing its guidance in 2024.

The USPSTF estimated that lowering screening’s starting age to 40 would avert 1.8 additional deaths per 1k Black women screened every two years

The Takeaway

Hopefully, we’ve seen the end of the “mammography wars” that led to the USPSTF’s 2009 guideline change. A better future is one in which breast screening decisions are made with consideration for factors like cancer risk in addition to just age.

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