The U.S. Preventive Services Task Force issued new guidelines on breast cancer screening today that do away with the “every woman should have an annual mammogram starting at age 40” recommendation women have long heard from their doctors.

The new recommendations are:
• Screening mammography should not be done routinely for all women age 40 to 49 years.
• Women and their doctors should base the decision to start mammography before age 50 on a woman’s individual breast cancer risk and her understanding of the benefits and harms.
• Women age 50 to 74 years should have mammography every 2 years.
• More evidence is needed for the USPSTF to recommend for or against screening mammography after age 74 years.

The new recommendations also note that:
• The USPSTF recommends against teaching patients breast self-examination.
• Available studies do not provide enough information to know whether breast examination by a trained medical professional adds benefit beyond mammography.
• There is not enough information to know whether newer types of mammography (digital mammography) or magnetic resonance imaging are any better than regular film mammography results.

The USPSTF is a group of health care experts that reviews published research and makes recommendations about preventive health care, and it’s recommendations are considered the “gold standard” for clinical preventive services. This means that these recommendations are likely to be widely adopted and have the potential to broaden all women’s understanding of the benefits and harms of mammography as well as help them understand what we truly know—and how much we still need to learn–about breast cancer prevention and early detection.

Many doctors now advocate that women begin mammograms at age 40. But the fact is the decision to change the age at which mammography screening begins in this country from age 50 to age 40 was always controversial and was never unanimously supported. That’s because mammography is not as good a tool in younger women.

The studies also are pretty clear that whether you have a mammogram every year or every two years after 50 the results are about the same. In fact, most European countries do mammography every two years, with similar results to those in the U.S.

Furthermore, the use of breast self-exam to “find cancers at a curable stage” has never been supported by randomized controlled data.

Recommendations on mammography screening must also take into account our new understanding of the biology of breast cancer. We used to think that all cancers were the same, that they all grew at the same pace, and that there was a window when all breast cancers could be caught before they spread. We now know that there are at least five different kinds of breast cancer based on their molecular biology. Some breast tumors are so slow growing and are so unlikely to spread that they will never do any harm. Others grow and spread very quickly. The idea that they all can be “caught early” is wishful thinking. In fact screening is best at finding the “good ones” that might even disappear if left alone. Remember the reduced the mortality from mammography is 30% not 100%! If early detection always worked, the number of aggressive cancers we see would have gone down as a result of screening. But as a recent article published in the Journal of the American Medical Association made clear, that’s not what has happened.

The goal of breast cancer screening should be this: to find the cancers that have the potential to kill you, so that an intervention is necessary and can make a difference. We need to stop finding the cancers that will never do anything, and stop over-treating women who have them.

For this to occur, we need to do help women understand what mammography can and cannot do, and focus on finding the cause of breast cancer and preventing it altogether. I don’t want women going for mammograms they don’t need, or feeling I false sense of security because they have had one. I want them to have the opportunity to take part in the research that we need to go beyond a cure! That’s the reason we started the Love/Avon Army of Women. [armyofwomen.org]. And that’s why I need you and everyone you know to sign up today!

Share →

143 Responses to The New Guidelines for Mammography

  1. Pam says:

    Dr Love – happy to see once again your casual dismissal of DCIS and the women diagosed with it. Until the medical community can determine beyond a shadow of a doubt which woman will end up with invasive cancer and which woman will not, screening, testing, and treatment are not optional.

    I was diagosed at age 46 via a mammogram. While my mother was dx with BC at age 62, because she was post-menopausal, I was told that the risk to me, her daughter, was minimal at worst. Lumpectomy, radiation, and tamoxifen and a year later diagnosed with LCIS after changes to a lesion found the year prior. Will I get invasive BC? Who knows? Will my daughters and nieces? Who knows? Will the insurance company deny payment for a 40 year old woman’s mammogram? Probably.

    I will take anxious feelings and a false positive any day over the risk of not discovering invasive breast cancer until it is too late for treatment. Just ask anyone in your Army of Women.

    Your Army just lost a recruit.

  2. Susan says:

    Hey, Nancy — are you actually reading any of this? Or just writing something that’s the equivalent of “everyone just calm down”? We are supposed to be fighting this disease with everything we have and instead a task force tells us to do LESS. Do you see the number of women here who would be dead if it weren’t for having caught their cancer earlier than age 50? Do you think this is just a small percentage of woman??? Let’s see how you feel about all this once YOU get cancer at age 41 and it’s not detected until age 50. We’ll talk then about who needs to take a deep breath.

  3. Venita Wood says:

    Dr. Love,

    I was shocked this morning when my husband showed me the newspaper article about the Task Force recommendations. I shook with anger.

    Then I come to hear about your position on the matter. I could not believe what folks were telling me, so I came to your blog. I thought you would be the first to attack the recommendations. You are our advocate for breast health. You are a revered expert on the subject. So I took a deep breath and carefully read your comments and the responses, and sought out and watched the GMA segment.

    I believe many of your arguments against early mammography and annual mammography for older women are statistically sound, but statistics don’t see the larger picture. Every single life saved by is precious, and a huge blow against the disease. I agree with you that this is a public policy matter. The respondents here are among those for whom policies are being established. Although these respondents, who are informed people with personal involvement with breast cancer, are as a group likely to be more opposed to the Task Force recommendations than the American public as a whole, I believe the American public will resoundingly oppose these recommendations. I, being a breast cancer survivor of 4 years, plan to be very proactive against these recommendations.

    (I am reminded of the Verizon commercial where the Verizon guy and the cable guy are getting feedback from a customer focus group, and the cable guy says “I don’t understand why we are asking them their opinion.”)

    I understand that mammography is an imperfect tool. At 53, my breasts were still so dense that neither mammography nor ultrasound could “see” my clearly palpable 4cm tumor. However I still encourage the women I know to get their annual mammograms. I encourage them to discuss other imaging techniques with their doctors.

    I am sad to say I no longer have a dog in this fight. I won’t be affected by any change in insurance coverage for breast imaging. I haven’t had to have breast imaging since my breasts were removed almost four years ago.

    I also am confused by your support for the recommendation that older women not receive annual mammograms. Older women are more likely to get breast cancer, and mammography is more effective on the less-dense breasts of older women. But, the only argument I see that you have for supporting that recommendation is that other places in the world perform mammography less frequently. That, for me, is not reason enough to reduce the frequency of mammography in older American women. That, for me, undercuts the validity of your other, more-sound arguments.

    (I can hear my mother now. Would you jump off the roof just because your brother did?)

    Yes mammography is imperfect, and yes false positives lead to anxiety and unneeded procedures, and yes we need a better screening tool and even more so a preventative for breast cancer. But we don’t have that replacement tool yet. Public policy maker should not throw the baby out with the bath water.

    I won’t even get started on breast self exams. I found my tumor through self exam.

  4. Louise says:

    I work in a small rural Mammography Center. In the last 3 weeks alone we have had 4 women diagnosed with breast cancer. The first was 42 yr old this was her 2nd mammo her 08 studies were clean. The other 3 were 48, 52, and 54 who never had mammograms before. All read by a Radiologist with ACR codes of 5 These recommendations set the progress we have made for women’s healthcare back 25 years. Sorry Dr.Love I would rather have a radiologist be 100% sure I don’t have breast cancer and have a biopsy and have it be negative than not have a biopsy and miss a cancer and be in a losing fight for my life. I would rather put up with the annoyance of having a mammogram yearly and endure the compression for a few seconds then miss a cancer and not be able to see my boys get married or see my future grandchildren, and miss growing old with my husband. No thank you to OBAMACARE. IT comes down to the fact that insurance companies want to pay for less and less. Radiologist’s face the biggest ligation in reading of Mammograms so yes most are very conservative and would err on the side of doing a bx and having it be negative then miss a cancer. Maybe we should look at limiting the payouts in lawsuits against medical providers. It comes down to money fist women health issues, then children, then the old and the infirmed. What’s next death panels? Oops that’s what these recommendations are psuedo death panels for women.

  5. Therese says:

    I logged on to Dr. Love’s wesite to look for what I presumed would be her angered response to the new mamography recommendations. I am shocked. I was diagnosed at 42 with infiltrating ductal carcinoma by a digital mamogram, no family history or prior indicators. I referenced the Breast Book extensively, and have talked up Dr. Love’s prevention approach to those who will listen and stop buying pink external hard drives, et al, for the cure. When the new health care debates started, I argued ferociously with my mother that there will be no ‘death panels.’ Whoops ~ guess I would have been diagnosed much later when the cancer had spread, probably beyond much hope of a remission. I agree with so many here – do not abandon those women you will help to prevent ‘false positives.’ Like someone wrote earlier, no one died of a false positive, and until there are other resources, why stop what works the best to date? I am going to wait few days and try and read much more to see if I really want to quit the army of women and stop giving out the book to friends and family. I don’t think there are many reasons to stick around anymore.

  6. Therese says:

    One more thing – I think it is pretty telling that there was no e-mail blast from Dr. Love to her Army e-mail list after the mammoraphy recommendations were made. She just threw and article up on her website and let people happen upon it, perhaps to minimize the fire. When she is announcing a study and calling for participalnts – she doesn’t just post to her site. that would reach only a small portion of people – like she is hoping her article will.

  7. Chris says:

    Dr. Love:

    I have worked on producing mammography equipment in the past 15 years, and spent all my careers on developing digital mammography systems that intend to detect cancer at the earliest possible stages. As part of my work, I worked closely with breast imaging centers all over the world and I know (and am sure you know better than I do) that many women found their cancers under age 50.

    I want to let you know like you are, many people like myself are in our prefessions because we care about what we do. I have the opportunities to meet so many peole during breast cancer awareness events through the years, and the sprirts of those cancer surviors are what drive me hard at work. If you still rememeber the faces of those you treated, I can not imagine how can you ever say what you said last night.

    You have been helping women through your great work. I am hoping that your supporters will continue to support your work, not your words from yesterday. As I believe what you do has a great cause.

  8. Donna says:

    I am so disappointed in Dr. Love’s opinion of these new guidelines. YOu have always been such an advocate for women and breast cancer. I was diagnosed with stage 2 breast cancer.( Estrogen positive tumor and 3 lymph nodes) I discovered it through self examination. How can you say it is not important. Even though I was over 40 when diagnosed I will insist that my daughters have mammograms at age 30 as my doctor recommended. I don’t care what this task force says. I think the insurance companies just don’t want to pay for any extra testing. Shame on them!!! and shame on you!!! How many women’s lives have been saved because they got mammograms and did self exams before the age of 50.
    I will no longer support you or your organization until you change your opinion. And who are the other people on this task force ARe they being paid off by the government and insurance companies?
    Also-wouldn’t you rather have a false positive then die???

  9. Jenny says:

    I’m sorry to see all of the venom here and on the NY Times web site. Dr. Love, please know that your army has won a new recruit. Let’s focus on women who are sick and need all of your expertise and that of your fellow doctors and leave the healthy, asymptomatic women alone. I hope that no woman will have to lose a breast, or even part of one, to DCIS ever again.

  10. Suzanne says:

    Thanks, Dr. Love. You are taking a lot of flak for sticking up for science, not emotion. Many women and health-care workers are invested in the current system of regular mammograms and can’t look at the subject objectively.

    To all those women who say they survived because they discovered breast cancer early through regular mammograms, I ask: how do you know the outcome would have been any different without the mammogram? In other words, you may have had a cancer that needed no treatment whatsoever. That is so hard for us to accept because it is drilled into us that early detection is the key to survival. If only that were true.

    I wish we could accept that some aggressive cancers will kill us no matter how early we detect them and no matter how much chemotherapy or radiation we throw at them.

    Mammography gives us a false sense of security. Thanks again, Dr. Love, for your willingness to speak out and take the heat.

  11. meredith says:

    this whole thing is absolutely unbelievable to me! I, too, am shocked to hear Dr. Susan Love, acting as though this is totally acceptable. While she indicates that the money from less than accurate mammography screening for women under the age of 50, could be better spent on other, more accurate ways of identifying breast cancer in younger women, there is no evidence that this study advocates this idea. nor does she put herself out there to demand such a course of action. For this study to suggest that women should no longer engage in breast self-exams (nor should their doctors routinely exam their patients’ breasts) is simply the MOST IRRESPONSIBLE thing I’ve heard in years! I, too, am a woman who found my own invasive lobular (very aggressive) breast cancer as a result of a breast self exam. I was Stage II (with a micrometastatic finding in one of my lymph nodes) when I found my cancer. True, the mammograms didn’t show it, but, ultrasounds did. Had I not been aware of my own breasts, and followed through on this, I would have been dead by the time I was a candidate for mammography according to this new study. I guess we are truly seeing the beginning of the new regime…welcome to universal healthcare!

  12. Jan says:

    Stand up, and fight healthcare rationing.

  13. Susan says:

    To those who support Dr. Love’s position because the science supports it — I am very scientifically minded. I don’t believe anything until it is proven to me. But on this issue, perhaps you (we) are missing the point that implying to woman that they can essentially ignore their health in this area until they are 50 years old is a large problem to create in itself. You are assuming that the majority of woman are going to be constantly up to date on the latest scientific evidence and follow accordingly. But that’s just not the case – you have to boil the issues down to the basics to make it “doable” and available to all, which is what 1) self-exams and 2) regular mammograms accomplish. You can’t tell people they can pretty much ignore this (because “self-exams don’t work” and “mammograms don’t find anything” and “early detection is a fraud”) and think that somehow they’ll be able to help their doctors with their health issues along the way. It seems to me this is putting ALL the pressure on the doctors to detect and none of the responsibility on the patients re: preventative care. And… just to be clear… are we somehow saying that self-exams and mammograms ordered in the past were all a big lie? Weren’t they based on something that still exists today? The American Cancer Society thinks so.

  14. Isabel says:

    My breast cancer was found at age 47, via mammogram. Well, being treated for breast cancer was no walk in the park. I assume however, that there was a reason why I had surgery, chemo, radiation, more chemo, Tamoxifen, now AI. If that treatment was not a waste of time and money … then it follows that the mammogram itself was not a waste of money, no? I’m not quite sure what the dollar value of my life is – but I am grateful that my doctors, nurses and society was willing to take care of me and pay the cost of my treatment. I try to live my life in a way that makes the expense worthwhile.

  15. Lisa Stewart says:

    Dear Dr. Love,
    I have read these many comments and I know what a hot topic this is and I told my husband that you would not support these guidelines and then I saw your interview and I was shocked! I am nurse for the past 23 years and one year ago at age 45 was diagnosed with Stage II Ductal Breast cancer, which was 99.9% Estrogen positive! I had no family history, I was the 1 in 8 women who get breast cancer. Mine was detected through a breast self exam and I new as soon as I had felt it that it was breast cancer. I then had a mammogram which showed I had not one, but three tumors in my left breast. One year earlier my mammogram had been negative.I then had a biopsy and was dx with breast cancer. I had a left mastectomy and complete removal of all lymph nodes. I then had 5 months of chemo therapy.I now have developed lymphedema and i am dealing with these new challenges, however I am here to deal with these challenges because of self breast exams and mammograms. I believe that this is like the reaction when doctors said HRT was bad for you and put women in a place where they had to talk to their doctors to see what was best for them. I do feel that what you should have said was that we should look at all recommendations carefully and that we should not just have a blanket statement regarding such an important issue. I also have worked at research hospitals and know that there are certain ways information should be released and someone in your standing as an authority in your field should present a more balance stance on this issue.I believe in research, but I also believe in doing what works and screening through self breast exam and mammograms for women 40 and above works! I really hope you address your followers here and explain your feelings.I feel you owe it to all the women and men who look to you as an “expert” in the field.
    Thank you,
    Lisa Stewart

  16. Rhondana says:

    I am another woman considered expendable by the Task Force and Dr. Love. At age 48, I had no family history of breast cancer nor any other rusk fctors but thanks to a rountine mammography I was diagnosed with Breast Cancer. I had a large, aggressive tumor, stage II. I am now 60 and would be DEAD if I did not have that routine mammography.

    When I was initially diagnosed I was given a copy of your book. I have since done the same for all of my friends who have been diagnosed. We trusted and relied upon you.I am shocked and disappointed at your reaction to the recommendations/guidelines and your obvious disregard for the value of my life. I feel betrayed by you.

  17. Maria says:

    Suzanne,

    You ask women who have survived because of a mammogram how they know the outcome would not have been different without the mammogram.

    Huh?

    So: a 40 year old woman has a tumor growing in her breast but doesn’t know it because she hasn’t had a mammogram. But that’s ok because it might just maybe go away by itself.

    A 50 year old woman has the same kind of tumor, a mammogram finds it, and now medical science says it’s ok for her to have a biopsy, lumpectomy,radiation,etc just because she fits into a statistical category that has been shown to benefit from mammograms?

    Is this what you and Dr Love call sticking up for science?
    Me, I’d rather stick up for my sisters.

  18. bparton says:

    This is just wrong. I was diagnosed with grade 3 DCIS on mammo at 47. Had I waited three more years for diagnosis, I would be terminally ill right now. What are you people thinking? I am not a statistic!

  19. Sunny says:

    I am a breast cancer researcher, and also a volunteer with the Army. I was not surprised to hear about Dr. Love’s support of the recommendations– I had heard her opinions before at conferences–but was absolutely shocked to see her publicly endorse these recommendations.

    From what I can tell, two main issues have been raised by the Task Force and echoed by Dr. Love with regards to screening mammography: 1. false positives i.e., benign lesions that are unnecessarily biopsied, and 2. overtreatment–maybe not all cancers detected by mammography will be life-threatening.
    These are certainly valid concerns.

    In the radiology community, lots of research is being performed today to try to improve screening tests to minimize the number of false positives i.e., benign lesions that are biopsied. Such research is critical, and scientists and clinicians should and do take it very seriously!

    With regards to overtreatment concerns, can Dr. Love or the Task Force or anyone else right now tell me which DCIS lesions or which small IDC will NOT be life-threatening? As a scientist in this field, I can tell you the answer is NO. WE DO NOT KNOW RIGHT NOW. Prior posts on this blog lament getting mastectomies for DCIS–I *completely* understand their concern. But who is to say their DCIS was certainly one of the indolent ones? The problem is, scientists and clinicians CANNOT identify indolent lesions. So again, we come back to research– we need to better figure out which cancers are killing cancers and which are not!

    So, just because there are some outstanding concerns about screening, should we change how we do things? No–we should do RESEARCH to IMPROVE the tests and our understanding. This is what research is for!!

    And this is why I am so disappointed– the Army of Women is supposed to be about research. And Dr. Love’s endorsement is not only a blow to women under 40–who according to the recommendations should not do self-exams, should not get clinical exams and should not get mammography i.e., they should just wait around to get a big lethal cancer (as Dan Kopans said so well). Her endorsement also undermines her commitment to research. I will be withdrawing my membership in the Army of Women.

  20. Phillip Fought says:

    In response to Angela Bailey of Canada….you say we are behind the times and should not base our policy on “hysteria and anecdotal evidence” but on scientific fact? How about this for facts?!? The whole of Europe, the UK AND Canada have higher death rates due to breast cancer than the US!!!! These are facts! Changing our policy to match your so called better science would mean joining you all in seeing death rates due to breast AND other cancers increase not decrease as is presently the case in the US.

  21. Barbara says:

    I am so grateful for Dr. Susan Love and her team of experts. I had my mammogram at 50 and was told something might be there, come back in 6 months, and then again, and again. Am I one of the lucky ones or am I not. To live with a maybe you have cancer is living in constant anxiety. My Dr was of no help. Only Dr. Love and her team have been able to give me the correct information to keep my anxiety in check. We have a generation of women who have been taught that mammography saves lives, it will take time to educate us all and understand. Thank you again Dr. Love and your team, you have my support and greatest respect.

  22. Linda says:

    Shame shame shame. Are you more interested in getting your “procedure” to be the standard test rather than mammography?? The fact that you believe those diagnosed in their 30’s and 40’s are expendable and lives aren’t worth the false positives is just disgusting. And how condesending could you be by stating “no one is taking away your right to be radiated”. Don’t patronize us. We get enough of that from the medical community and sure as hell don’t need it from you.

  23. June says:

    After the evening news on which Dr. Love appeared Monday night, a doctor from the Siteman Cancer Center in St. Louis appeared on the local news. She said that the data the task force looked at was not complete and if they had used ALL the data, their findings would have been different. Anyone can manipulate data to support their findings. I’d like to see findings of the true, complete data.

    To those of you who say, “calm down”, “take a breath”, I say talk to us when you or a loved one has heard the words “You have cancer”, when you have the rug ripped out from under your feet, when you try to figure out how you’re going to keep working full time while going through treatment, when you have to explain to your children why you’re going to lose your hair.

    To the survivors here who think they were over-treated, I say at every step in my treatment I had the option of researching my options for myself, of seeking a second opinion, and even of not having the mammogram in the first place (at age 44).

    What I am saying is don’t take away or jeopardize our right to have our insurance pay for a routine mammogram at age 40.

    And Dr. Love, I have no idea if you have any monetary interest in promoting this task force’s guidelines, but as a physician who has taken an oath to save lives, why are you advocating anything that could endanger even one life?

  24. Tracy says:

    Dr Love,
    I hope that no 29 year old mother of two in your family goes undiagnosed because of the new guidelines. SBE saved my life and I will collect cans if I have to to make sure that my girls get early screening. They may fall into the smaller percentile, but their lives matter to me and mine matters to them. You can take your Army and shove it up your ass. It’s clear that you don’t care about us and I don’t want to march with you.

  25. B. Stockton says:

    As a 34-year old breast cancer survivor (diagnosed at 33) with no family history or obvious risk factors to speak of, I have serious problems with the USPSTF’s recent recommendation for new screening guidelines.

    A breast self-exam saved my life and had I not preformed this test, and had I waited until even 40 to get screened, I probably wouldn’t have lived to receive my first mammogram.

    When I had that mammogram, it lit up with suspicious calcifications. I was sent immediately for a biopsy. The mammogram seemed to work just fine on my “young and dense” breast.

    There’s no telling how many other young women share this same story. It’s been proven that early detection saves lives, and all reports seem to show that breast cancer in young women in on the rise. Why, then, would the USPSTF want to push the screening age further back? Of all things, discourage self-breast exams?

    After looking in the many faces of other young women like me, you can’t help but wonder why the screening age isn’t, in fact, lowered. That the USPSTF thinks women should wait until age 50 strikes me as simply outrageous.

  26. Marianne S. says:

    This is absolutely insane. I was diagnosed with BC when I was 48. Never had cancer in my family and I was lazy at least on the self exams. Had I been smarter and gotten my mammo’s yearly, I could have been diagnosed sooner and probably not had to go thru chemo. As it stands I had surgery,chemo and radiation and am on a 5 year drug to try to prevent BC from coming back.
    The fact that this is a government task force finding, in the midst of a health reform change, which to me seems to be leading to socialized medicine, scares me even more.
    Women know that we are most vulnerable in our 40’s ,especially with estrogen based cancers, but I have met more women thru my experience going thru treatments in their 30’s than ever before. And they would die if not diagnosed. Furthermore belonging to group the Army of Women,I am furious that Dr Love herself has agreed with these new “findings”. We survivors must start getting involved to help our mothers,sisters,daughters,families, friends be able to fight this type of health reform. In ten years I would almost guarantee the breast cancer survivor findings will be much different, and not on the good side either.

  27. Marianne Miro says:

    Dear Dr. Love,

    I am sad that you find it necessary to punctuate your belief that we need to change our standard for mammography by demeaning women (many of whom lives were saved by mammography) with your condescending comment “right to radiate yourself”. While I am in full agreement that mammography is not the best way to find many cancers (and in my case it totally missed it), the way that you express your opinion is dismissive and disrespectful. We may not all be doctors, but we still deserve your respect when addressing an issue that could impact our life or death.

    Marianne Miro

  28. Shana says:

    Barbara, I had a mammogram 4 years ago, at age 54, and was told there might be something in my left breast and to come back in 6 months. Had the second mammogram, nothing had changed and was told to come back in one year. I was not anxious the six months waiting for the 2nd mammogram. I trusted my doctors and went about my life. This past Aug, I had my yearly mammogram and again the mammogram found something but in my right breast. Again I had total trust in my doctors and was gaining so much knowledge as to what the possible diagnosis could be. I remained calm, did some research online and waited for my doctors to give me the results. After another mammogram, ultrasound, biopsy, and a MRI, the results were stage 2 Invasive Lobular Carcinoma. The MRI detected cancer in my lymph nodes. The MRI also showed that my right breast was cancer free. The new guide lines of mammograms every two years would have worked for me 4 years ago, but not this time.
    Young women, under 50, statistically have more aggressive growing tumors. How can anyone consciously recommend these guidelines without a better alternative????

  29. Kavita says:

    I am appalled by these new guidelines. I was diagnosed with breast cancer this past July at the age of 43. There was no history of breast cancer in my family. I thought I had done all the right things to prevent breast cancer including having my first child before the age of 30, breastfeeding, eating in a healthy manner, and exercising diligently throughout my life. Because my invasive cancer was caught by an annual mammogram in an early stage, I did not require chemotherapy and have an excellent prognosis. I shudder to think what my prognosis would be if my first mammogram was at the age of 50.

  30. Mary Peterson says:

    I understand the difficulty in identifying breast cancer tumors in young women with dense or fibrous breast tissue. However, my personal breast cancer journey began with a diagnosis at age 38, when my gynecologist discovered a lump during my annual physical. The lump did not show up on mammography even after knowing it’s location, and ultimately turned out to be a 0.8 CM DCIS. I didn’t regularly do BSE because I really had no idea what I was feeling or not feeling. What if I had not been consistent on my gynecological care? The lump would like have gone unidentified until later.

    Many, many of my friends were diagnosed before the age of 50, some with mammography, although no all. 1/1900 women age 40-49 have breast cancer per USPSTF determination. July 2008 US population estimate of women age 40-49 = 22,327,592. The new guidelines could
    result in 11,751 US women/year going undiagnosed with breast cancer until later stages.

    I believe the new guidelines are short sighted and will likely increase the number of late breast cancer diagnoses and deaths.

  31. P Costantini says:

    My mother had Stage 2B detected by mammogram 18 months after her last clear mammogram. If she had waited two years, her cancer would have had 6 months to spread.

    My cancer was detected at age 42 on mammogram. In clinics, support groups, and online boards, I cannot tell you how many under 50, no family history women I met battling Stage 2 or 3 cancer. I am certain deaths, or later stage detection will rise if these guidelines are followed.

  32. Kelly S says:

    Really?! All in an effort to save money. I find this appalling. I found my cancer (5-6 cm tumor)after a self breast exam. Just 3 weeks before finding that I had a clinical breast exam which detected nothing. I was Stage 3 within 3 weeks of not feeling anything. I was not in the high risk category. Had I not done a SBE I shutter to think what stage I would have been. I was 32! I was sent for a mamogram but with the new recomendations would that have been harder to do? What will these new recommendations do for the next person (people) with a case like mine or the many people I know who had their cancer detected by mamography (in their 30’s or 40’s). I have been a member of the Army of Women but will not be apart of it anymore.

  33. Chris says:

    Here is a link to the USPSTF website for the details of their new recommendations, and their summary:

    http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

    Summary of Recommendations
    The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.
    Grade: C recommendation.
    The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
    Grade: B recommendation.
    The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
    Grade: I Statement.
    The USPSTF recommends against teaching breast self-examination (BSE).
    Grade: D recommendation.
    The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
    Grade: I Statement.
    The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
    Grade: I Statement.

    Please pay attention to the recommendation grade. For example, the recommendation grade is C for the 40 to 49 group. If you read the definition of Grade C, it basically means that the recommendation was made WITHOUT strong scientific evidence.

    So for those people who make claims that the decision was made by a group of independent of scientists based on science, they need to understand how the conclusions were reached by the committee. It is NOT based on science. But rather the recommendation was made based on the AGREEMENTS by the “experts” served on this task force. What’s more disturbing is that there is nobody on the panel who has experience in mammography, and in breast cancer treatment.

    Just facts.

  34. Kay says:

    Dr.Love had been my “hero” when I was diagnosed with Stage 1, IDC in 08/08. Her book helped me in my decision making process, much more so than my doctors. To hear her on NBC Nightly News, supporting these Task Force guidelines, was disappointing to say the least! I am 55 yrs. and my tumor was found at 1.3 cm, on my yearly mammogram. How big would it have been if I had waited two years as recommended by the Task Force! I am a trained medical professional, in laboratory medicine. Let ME decide if a biopsy is stressful. I was able to have a lumpectomy & radiation. If you want to talk about stressing a patient, tell her she now has to have chemo because we didn’t find it soon enough!

  35. Julie says:

    I just emailed to have my name and membership deleted from An Army of Women. Your stance on this issue makes no sense! I am 59 years old and have had a mammogram every year like clockwork. In June 2008 they found a mass which turned out to be invasive breast cancer, I had surgery, radiation and now return to the doctor every three months for follow up. I was told that if I had waited and not had the mammogram when i did the outcome probably would have been much worse. I’m sorry these new recommendations smell like insurance companies are dictating the decisions.
    I think your army just deserted!

  36. Eleanor says:

    Dear Dr. Love,

    I am speechless at your condoning these recommendations re. mammograms!

    How in God’s name will you sleep at night knowing that there may be thousands and thousands of MOTHERLESS children because of these new guidelines!! I am married to a gynecologist, and as he said, they are not interested in saving lives, they are interested in saving money!! Better get yourself a sleeping aid to deal with the guilt, as well as a HUGE fall in your patient load!!!!!

  37. Amy says:

    I am also appalled at Dr. Love’s stance on this issue. I was diagnosed with triple-negative, agressive BC at age 49 in a routine mammogram. It was deep and not even the doctors could feel it. If I had waited just one more year, it would have been much larger. My 2nd cousin had the same diagnosis with a larger tumor at age 39. Had she been getting mammograms since 35 (which is when I think they should start), it would have been much smaller, perhaps saving her breast. I was planning a year-end donation to the Love Foundation, but definitely will not be sending it now.

  38. Chrysti says:

    The general’s mind has gone AWOL! I was promoting army of women to many. Brilliant idea I think (army of women) but the leader of the pink army has lost a HUGE amount of respect. We need a new general.

    All you have to do is visit some breast cancer forums to see how many people were saved by early detection. If you are so desperate to save money I can understand the mammogram recommendation (though it will kill many). But supporting no self exams is extreme reckless behavior. Why, why would they recommend that. All the 50 and under cases are to die? What about all the motherless young children? I also can not believe the ignorance of thinking it must be ok b/c Europe does it. They have horrible health care people. Talk to people who live there. The wealthiest of people fly to the USA for care. Educate yourselves people.

    I agree that we need improvements in the system BUT they are jumping ahead of themselves. I agree that getting rid of radiation is the way to go. We are not ready though! Yes, we need better tools, but are we to raise the death rate to get there?

    I was not high risk and 44 when diagnosed. My eight year old daughter would be without her mother had it not been for the care I received.

    The PINK army needs to take this to the streets! Our lives DO have meaning!

  39. Ana says:

    Dr. Love: Will you respond? It is difficult to advocate for Army of Women when so many are outraged with the new recommendations.

  40. Rebekah says:

    Good for Dr. Love!! I hope she stands firm against all the rage that is being directed at her. I was diagnosed with non-invasive DCIS 3 years ago and had a lumpectomy. (I found it myself during a self examination) Unfortunately, they did not want to stop there. I was sent to a radiologist who took it for granted that I would also have radiation and tamoxifen. Because I had done research on my own, of course I refused. When I told him of my decision and why, his reaction was offensive, insulting, and he tried to frighten me into changing my mind. The fact is that many physicians will over diagnose and subject women to possibly harmful radiation and dangerous drugs even for stage 0 “cancer”. Hopefully it is out of ignorance and not because it is an industry and it is their livelihood. Having said that, The anecdotes about the lives that were saved can not be easily dismissed and ignored. However, my hope is that the 180 degree turn that these new recommendations represent will cause women not to take doctors recommendations at face value, do their own research, and make educated decisions based on facts and science, not emotions or fear.

  41. Susan says:

    I am a 15 year survivor of BrCa with which I was diagnosed at age 44. I am not unique.
    I am disgusted by Dr. Love’s stance, particularly since the panel of experts does not include an oncologist. The study was completed on older mammography equipment.
    Statistics are merely numbers, and the insurance companies look for excuses at the expense of lives to cut costs.

  42. Nancy Milne says:

    I absolutely do not agree with the new recommendations for breast cancer screening.
    At age 40 I had a base line mammogram. I was happy to learn I had healthy, albeit, dense fibrous breasts.
    At 42 I found a pea size lump in my right breast when performing my monthly self breast exam (now not recommended to do). My doctor sent me for a mammogram and also did a needle biopsy. The biopsy was clear, however, the mammogram indicated micro calcification’s. Another biopsy was performed which removed the lump and surrounding tissue. The lump was indeed just a cyst but I was diagnosed with intra-ductal carcinoma. I had a modified radical mastectomy. My cancer was Stage 1 and had not reached the lymph nodes. It was detected early enough that I did not have undergo chemo or radiation.
    I wonder if the current recommendations were in place then, would I be alive now, writing to you at age 60?
    I whole heartedly believe that the mammogram and doctor who read it saved my life! I also believe that the only thing the new recommendations will accomplish is to allow health insurance companies to deny younger women a form early detection in order to boost their bottom line. Or, is this recommendation released now in advance of a National Health Insurance to “shave off” costs being told to the American people? Conspiracy theory?? Hmmmm…
    Dr. Love, I am shocked that you are aligning yourself with the new recommendations. Over the years I have heard you speak to all women that early detection can and does save lives. Why now, are you reversing your stance for women in the 40-49 age bracket?
    As you can see from above I fell into that category 18 years ago. To whose benefit would it have been if I even reached the age of 50 for my first mammogram? Oh yes, of course, the insurance company that paid most of the fee’s to allow me to survive!
    I understand that we must find a cure for this horrible disease, but until we do, resources for early detection must be kept available to ALL.

  43. Carol Conti says:

    What about Thermography???
    My Thermogram found my breast cancer when my Digital Mammogram did not!!!!!

  44. Rebekah says:

    Obviously the posters who are expressing shock and anger at Dr. Love’s support of the new recommendations have never actually read any of the research on her website. Apparently, she has been putting the facts out there regarding the efficacy of mammograms and SBEs before age 50 for years and years.

  45. Maria says:

    Amazing that such an expert on breast cancer would agree with these ridiculous findings. I was diagnosed at age 30 but not with a mammogram.I have a family history but tested negative to BRCA1 and 2. I know so many more women now in their YOUNG 40s who were diagnozed via mammogram on their 1st screening. You are gonna tell me that that cancer wasn’t growing long before that mammogram screen picked it up? Shame on you Dr. Love. I wonder how many 40 – 50 year old breast cancer survivors are going to want to be soldiers in an Army whose leader thinks they don’t matter. What do you say to all the survivors alive today whose cancer was picked up on a mammo between ages 40 and 50?

    As a woman with boobs and at risk for breast cancer, I sure hope Michelle Obama has enough sense to kick her husband and his stupid health care reform right where it hurts.

  46. Caroline Power Gangl says:

    When I first heard about the task force’s recommendations, I was in disbelief. When I saw Dr. Love on Good Morning America supporting the recommendations, I wanted to scream. I was diagnosed with DCIS with a microfocus of invasive cancer thanks to a screening mammogram at age 42. No family history of breast cancer. I wasn’t very good at self-exams because my breasts were “lumpy.” I had a lumpectomy and sentinel lymph nodes removed. Cancer was ER/PR positive, and biopsy showed a second cancer within the tissue removed. I had 7 weeks of radiation and have been cancer free for four years. Can you imagine my daughters’ lives right now at age 8 if my cancer hadn’t been detected early? Shame on you, Dr. Love. Every life saved through screening mammograms starting at age 40 is worth lifetimes more than the inconvenience of some women having false positive results, which are determined to be true negative results on further examination. All those women with false positives should be getting on their knees and thanking God when they learn they don’t have cancer.

  47. Mary Hamilton says:

    Dr. Love, I first came across your name when my mother was diagnosed with Breast Cancer and was given a copy The Breast Book to help me uderstand what we were dealing with. May my mother rest in peace. I have given your book to many women and have been a true supporter. I have always agreed with your strategy to find the cause so we can help with a cure. So much so, that I helped to organize a charity event benefiting the Dr. Susan Love Research Foundation and sent you a check for $30,000. What I can’t understand is how you expect us to carry on until you find the answers to the cause through your research. That is the future – hopefully a future filled with the answers to this disease that you’ve been searching for. How can we fight today? How can we prevent another from dying today? The answer – early detection. How do you detect early – mammogram screening and self breast exams. I will continue to fight for my life by demanding to be examined. I deserve it, my life is worth it. My mother is not resting in peace at this very moment….I know she is appalled at the decision of this government to make such a statement and at those that support the guidelines. I will no longer be and advocate of your foundation and will withdraw my financial support. I wish you the best of luck in your endeavors in research. But we need to live TODAY. Ironic, I had my mammogram today!

  48. Janet says:

    A mammogram at age 40 saved my life. At the time of my diagnosis I was living in a foreign country where routine mammograms are not performed until age 50. I insisted on having my first mammo at 40 simply because I knew that the US guidelines recommended it. The mammogram spotted my early stage invasive cancer straight away and I am here to tell the tale. Mammograms do save lives even in women under 50 – just because there are fewer of us, does that mean our lives don’t count??

  49. Jenny says:

    Dr. Love, please do your best to educate the world about DCIS. The New York Times hasn’t touched it. Strangely, the best discussion I have seen of it is on a Newsweek blog.

    I was diagnosed with DCIS a few months ago at the age of 46. It was low-grade, so, as you describe in your book, it was spread out and hard to pinpoint. Like a good girl, I had a lumpectomy, but not surprisingly, the margins weren’t clear. Now my choice is a re-excision, which will be cosmetically unappealing, or a mastectomy, which is a major surgery that I would rather not endure.

    Do I feel like a survivor? No. I can’t help but think that I wouldn’t be sitting here with a big scar if I lived in Vancouver. Or if these recommendations had come out a year ago (and you can bet, I would not have gone for my mammogram, given my lack of risk factors). I consider myself the poster girl for unnecessary treatment.

    I saw your appearance on the MSNBC web site and was very impressed. Please don’t give up.

  50. Lucinda says:

    Well, here we are back when women’s lives mattered little. I think 1 in 1,900 cases is a large number of women to tell they don’t matter because that is what this study is telling them. I, for one, think 1 life is too many to lose to breast cancer.

    Those with DCIS – don’t get complacent – my sister’s breast cancer started with DCIS and was local disease by the time she had surgery to remove the breast and was well on it’s way to metastisizing. My other sister was diagnosed at 45 with a very agressive breast cancer – the same my mother was diagnosed with 2 years before. The kicker is that my sister with the DCIS was the first member in my family to be diagnosed with breast cancer – ever.

    Dr. Love you should ask Susan Komen if the recommendations are a good idea – oh but you can’t because she died of breast cancer with the ‘wait and see attitude’ and she was 36. I won’t resign from the Army of Women because I think we need to do all we can to fight the disease. I will just bear in mind that some of us are expendable because of our age.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>