Are annual mammograms actually necessary?

To mammogram or not to mammogram—it’s the debate that never ends, despite the fact that Europe has had this issue down for decades. And here we go again, as yet another new screening guideline makes headlines.

Only this time, it’s following the recommendation I always make—and the recommendation of many other countries worldwide. (Countries that happen to have lower rates of breast cancer than we do.)

Which is that women with no breast cancer symptoms should be getting mammograms every other year. This applies to any average-risk woman between ages 50 and 74. Past that age, mammograms should stop altogether.

Biennial screening for average-risk women

This latest recommendation comes straight from the country’s largest medical specialty organization, the American College of Physicians (ACP). And it consists of four statements:

  • Average-risk women between 40- and 49-years-old should talk with their doctors about mammography before the age of 50. The focus should be on the woman’s screening preference as well as potential harms and benefits (the former of which generally outweigh the latter at this age).
  • Between ages 50 and 74, average-risk women should be offered breast cancer screening by mammogram every two years.
  • Doctors should stop performing mammograms in average-risk patients over the age of 75, and in patients with a life expectancy below ten years.
  • Clinical breast examination shouldn’t be the primary breast cancer screening method for any average-risk woman, regardless of age.

Obviously, this is a pretty simplistic set of guidelines. It doesn’t, for example, consider that women who have dense breasts may need extra screening (or at least ultrasounds to confirm results).

It also doesn’t consider factors like early menstruation, late menopause, birth control or hormone replacement therapy (HRT) use, or family history of breast cancer. All of which, in combination, would easily bump a woman out of the category of “average-risk.”

So, what constitutes “average risk?”

  • Not having a personal history of breast cancer or any other high-risk lesion
  • Not having genetic mutations like BRCA 1 or 2
  • Not having any family history of breast cancer
  • Not having a history of radiation therapy to the chest in childhood—though apparently, using cancer-causing radiation to look for breast cancer as an adult is perfectly okay. Think about that for a moment…

Radiology groups cry foul

So why the update? Well you can credit a long overdue dose of common sense for that.

Ultimately, the goal was to extract the most essential parts of diverging guidelines from authorities like the U.S. Preventive Services Task Force, the American Cancer Society, and the World Health Organization. (And in case you haven’t noticed, these guidelines are all over the place.)

In their guidance, the ACP points out that randomized clinical trials don’t show a reduction in all-cause mortality with mammography. Still, I’m going to let you guess who has decided this is rubbish, and came out in loud disagreement…

If you guessed the American College of Radiology and the Society of Breast Imaging, then—BINGO!—you’re right. Both radiology groups stand by the need for annual mammography, starting at age 40 and continuing for as long as a woman is in good health.

Note that I said radiology groups. And why do you think they’re so outraged over these latest recommendations? Sure, it could be that some research shows a decline in breast cancer-specific deaths with routine mammography…

But could it also be because they stand to lose millions and millions of dollars in the call for less frequent imaging???

I don’t know about you, but given the facts, that sounds like the most plausible theory to me. In the end, the choice about when and how often to receive a mammogram is yours to make. All I ask is that you make it an educated one.

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ACP: Breast Cancer Screening Every 2 Years.” Medscape Medical News, April 9, 2019. (