Don't screen based on risk alone, groups say
Though the American College of Radiology (ACR) and Society of Breast Imaging (SBI) agree with the report, they say that ordering mammograms based primarily on risk would fail to detect-and potentially treat-breast cancers.

They cite a report published in the American Journal of Roentgenology, which says the USPSTF's screening guidelines would cause the death of approximately 6,500 women a year in the U.S. The report says that thousands more would have to undergo treatments under that guideline than if their cancers were detected early via mammogram.
The ACR and SBI issued a statement reiterating their belief that the authors put too much emphasis on the obsolete and low-lifesaving benefits of mammography that are in old studies. They cited a Canadian National Breast Screening Study that has already been condemned numerous times and should not be in their analysis. (The World Health Organization excluded the CNBSS from its assessments on how mammography impacts breast cancer deaths.) The groups reference a recent article in The Oncologist that says many studies in Pace and Keating's article discussing overdiagnosis and potential harms of mammography are not as well-founded.

Are mammograms really harmful?
A recent study published in Cancer showed that more than 70 percent of women in their 40s who died from breast cancer were among the 20 percent of women who were not being screened.
According to National Cancer Institute data, the breast cancer death rate in the U.S. dropped 30 percent since mammography became popular in the mid-1980s.

Dr. Carol H. Lee, chairperson of the American College of Radiology Breast Imaging Communications Committee, said that the ACR and SBI are sticking to their recommendation that women at an average risk for breast cancer should begin getting an annual mammogram at 40.

"We do not recommend that mammograms be performed less often for any age group or risk level," Lee said. "It is important to understand that the majority of breast cancers occur in women with no identifiable risk factors. Therefore, if the decision to screen is based on the level of risk, most breast cancers will go undetected until they are bigger or palpable."

Lee said that Pace and Keating show that mammography has led to a decrease in breast cancer deaths.

"This crucial fact has been overshadowed by the inappropriate emphasis on the downsides of mammography, namely false positives and possible overdiagnosis," Lee explained.

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