When it comes to deciding how often women should undergo breast screening, the opinions of one important constituency are often ignored: women. Researchers from Philadelphia asked women for their preference, and more than 70% said they wanted screening every year, according to a study to be presented at RSNA 2017 in Chicago.
The frequency with which women should undergo breast screening has been debated fiercely since 2009, when the U.S. Preventive Services Task Force (USPSTF) changed its recommendation from annual screening to screening every two years beginning at age 50, according to a team led by Dr. Ghizlane Bouzghar from Einstein Medical Center Philadelphia.
The task force reaffirmed this recommendation in 2016, stating that its resistance to annual breast screening was based in part on "harms" associated with mammography, such as the diagnosis and treatment of breast cancers that would otherwise not threaten a woman's health and the unnecessary biopsies and associated anxieties resulting from false positives. Other professional organizations, such as the American College of Radiology (ACR), recommend that breast cancer screening begin at age 40 and continue yearly.
What do women prefer?
The debate over when screening mammography should start and how often women should be screened has lacked a key component: women's preferences, Bouzghar said in a statement released by the RSNA.
"The USPSTF associates annual screening mammography with 'harm' and recommends biennial screening mammography instead," she said. "However, there is no study to date that looked at women's preference regarding annual versus biennial screening mammography, and whether women think that biennial screening causes less, equal, or more anxiety."
Bouzghar and colleagues surveyed 731 women undergoing screening and diagnostic mammography at Einstein between December 2016 and February 2017. They asked women about the following:
- Whether an abnormal mammogram or breast biopsy causes emotional harm
- Whether screening every two years caused them more or less anxiety
- Whether they preferred to have a screening mammogram every other year or every year
The researchers also took into account factors such as a woman's age, race, family and personal history of breast cancer, prior biopsies and abnormal mammograms, and underlying anxiety disorders.
The result? Of the women surveyed, 71% preferred to be screened every year, and women with a family history of breast cancer and/or a history of prior breast biopsy had an even stronger preference for annual screening.
Women understand that yearly mammograms save lives, and they don't consider mammography's potential downsides to be as compelling as getting screening, the researchers concluded.
"Women are much better educated about the value of screening mammography than they are given credit for ... [and] the USPSTF's concerns about mammography's 'harms' are somewhat paternalistic," Bouzghar said. "In 2017 women are more empowered about many things, including their healthcare."