In November 2009, the U.S. Preventive Services Task Force issued a new recommendation that women under 50 should not have routine screening mammograms unless they are in a high-risk category. The group's previous advice was for women aged 40 and older to get routine screenings every year or two. The new guidelines also recommended against regular breast self-exams. The task force came to their conclusions based in part on the fact that mammograms produce false-positive results in approximately 10 percent of cases, resulting in unnecessary anxiety, follow-up tests and, in some cases, treatment. We present our reasons for disagreeing with the Task Force recommendations below.

Reasons to have regular mammograms between ages 40 and 49 (even if breast cancer risk is low)

Screening mammograms and self-exams have saved the lives of many women in their 40s. The Task Force's recommendations apply to "women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation." However, all women with a first-degree relative with breast cancer are at increased risk for breast cancer compared to the general population, not just those with family members who have BRCA1 or BRCA2 breast cancer gene mutations. In addition, women with benign fibrocystic breast disease, previous breast biopsy, and hormone replacement therapy (for example, after hysterectomy) all are at significantly increased risk. Finally, most cases of breast cancer among women in their 40s are found in those not in a high risk group. For example, one study of women aged 40 to 49 group (who were screened with mammograms and found to have breast cancer) reported that invasive breast cancer was diagnosed with equal frequency in women presenting with or without a family history.

Below are reasons for even those women not at heightened risk for breast cancer to have annual or biennial screening mammograms during their 40s.

• Breast cancer diagnosed during the 40s is not extremely rare compared to breast cancer diagnosed during the 50s; 17% of 2006 breast cancer deaths were among women diagnosed in their 40s whereas 22% of breast cancer deaths were among women diagnosed in their 50s
• Screening mammograms find breast tumors at their earliest, most treatable, and most survivable stages
• Breast cancer in younger women women tends to be more aggressive (and therefore more deadly) than breast cancer in postmenopausal women, so that there is greater benefit for early detection in younger women
• Women with dense breasts are more likely to develop breast cancer than those whose breasts consist almost entirely of fat. Excluding mammograms for younger women (who are more likely to have dense breasts) based in part because such mammograms are hard to interpret reduces screening for a vulnerable population
• Mammograms produce false negatives as well as the false positives highlighted by the Task Force. This is especially true for lobular breast cancer, which is difficult to detect radiologically. Having earlier and more frequent mammograms increases the odds of finding hard-to-detect cancers
• While Caucasians are more likely to develop breast cancer during their lifetimes, Latinas (median age at diagnosis: 54 years) and African Americans (57 years) tend to be younger than Caucasians (64 years) at diagnosis. Californians with Asian/Pacific Islander ethnicity have also been found to be diagnosed at earlier ages than Caucasians living in the state. This suggests that mammograms starting at age 40 may be particularly important for non-white women
• A previous mammogram can assist a radiologist in making the determination as to whether a suspicious area is likely to be cancer by providing a baseline for comparison purposes
• The core needle biopsies routinely used to investigate suspicious lesions found on mammograms are not particularly painful or hugely expensive. The cost of a biopsy and the related anxiety pales in comparison to the cost and anxiety of dealing with advanced breast cancer.

Breast self exams are useful in enabling a woman to have a comfort level with her breasts and to recognize their normal feel and appearance. Changes that take place over a menstrual cycle can indicate that a lump is not suspicious. A woman with lumpy breasts will be less likely to undergo unnecessary further testing and treatment if she finds a variation that is normal for her. Not all breast cancer forms lumps. Changes in the skin or nipple, an increase in the size of one breast, newly irregular breast shape, or an area of increased firmness can also be signs of breast cancer and should not be ignored.

The problem of inaccurate mammograms is not solved by restricting the use of mammograms

The underlying problem is not that women are having unnecessary mammograms but that mammograms, especially in younger women, are not accurate enough. False positives, false negatives, and problems evaluating mammograms of dense breasts are all emblematic of difficulties with regard to mammograms.