The U.S. Health Care Financing Administration, however, only reimburses women age 65 and over for screening mammograms done every other year.

Researchers in both the United States and Canada reaffirmed that women should continue to receive breast cancer screening, despite the scientific discussions. "The results of this study should not be used to deter women from having mammograms," said Yaffee.

Feig and Kopans argued that centers volunteered to participate in the study and were permitted to use whatever mammography equipment was available. No special training was given to those performing or reading the mammograms, and reports of poor quality were left uncorrected, they said.

Barriers to mammogram has largely been explored through the women’s lens. However, it is important to note that HCP factors can have an impact on counselling for mammograms. In this study, HCPs who had had mammogram and had testimonies of family members or friends gaining positive benefits mammogram, felt that they were able to share their personal experiences which would make their counselling more persuasive. On the contrary, those who had not done mammogram felt that they could only provide the limited factual information they were taught. Thus, HCPs’ own practice may influence patients’ choice for mammogram screening. Further, HCPs who had longer work experience and counselled more patients were more likely to be confident in providing counselling. Martinez and colleagues [30] found that HCPs with more than five years of work experience reported higher confidence in providing counselling for a mammogram

n a previous literature review conducted in Singapore [14], the patient factors and healthcare system factors highlighted were misconceptions, fear of mammograms results, cost, and accessibility to screening. However, the issues with accessibility and cost had been addressed using mammogram buses managed by voluntary welfare organisation which went to the neighbourhoods to perform screening free of charge.

“if she’s younger than fifty (years old), then the use of mammography compared to ultrasound is (that) there is a grey area whereby which one picks up abnormal breast lesion better. So, it’s still up to the clinician’s discretion in terms of which modality suits the patient.” (HCP 26)

English is the default lingua franca in Singapore although a wide range of languages, such as Chinese, Malay, and Tamil, can be used. Not all women are proficient in English. Some of them were only able to speak their ethnic mother tongue or dialects which the HCPs were unable to speak. The HCPs felt that the language barrier affected their ability to initiate discussions on mammogram screening

Male HCPs expressed their gender being a limitation. Although they felt comfortable initiating discussions with women on mammography screening, they acknowledged their limitation of not being able to share any personal experiences. Also, they were aware that some women might prefer having a female doctor to discuss mammography screening with them.

This study generated insights on HCPs’ perspectives to initiate discussions on mammogram screening. HCPs’ information mastery and personal experiences with mammogram screening were enablers in initiating these discussions. Lack of information in the health records was a barrier to providing continuity of care. Mammogram counselling should be provided in the women’s native language, with brochures being provided in various languages at the healthcare setting. A buddy system can be initiated, whereby HCPs who are new in providing mammogram counselling can do so with another experienced colleague to build confidence. Ancillary staff in the healthcare institution can also be trained to provide information to women on mammogram screening, and facilitate further discussions if required.

Numerous online resources can provide more information, including the American Cancer Society, the website Dense Breast-info and the American College of Radiology.

our research found that few women have such conversations and that many providers lack sufficient knowledge about breast density and current guidelines for breast screening.

Data shows that supplemental screening with ultrasound, MRI or contrast-enhanced mammography may detect additional cancers, but there are no prospective studies confirming that such additional screening saves more lives.

A newer type of mammography imaging called tomosynthesis produces 3D images, which find more cancers among women with dense breasts. So, researchers and doctors generally agree that women with dense breasts should undergo tomosynthesis screening when available.

Having dense breasts also increases the risk of getting breast cancer, though the reason for this is unknown.

While evidence is clear that regular mammograms save lives, additional testing such as ultrasound, MRI or contrast-enhanced mammography may be warranted for women with dense breasts.

Discussion Questions1) Do you think women should delay getting annual mammograms until they reach 50? Explain your position. 2) Why do you think there was such a strong public reaction to the announcement of the new guidelines? 3) How do you think the federal task force could have communicated its mammogram recommendations more effectively? 4) Do you think annual mammograms in women aged 40–49 leads to overdiagnosis and overtreatment? Use evidence to support your view. 5) Talk to your family doctor to find out what he or she thinks about the new mammogram guidelines. What is the doctor's position and how will he or she advise female patients?

Opponents Argue New Guidelines Could Cause Cancer to Go Undetected

Supporters Argue New Guidelines Will Reduce Harm Caused by Mammograms

However, in recent years a growing portion of the medical community has questioned whether it is in a patient's best interest to look routinely and actively for cancer with such technology, which tends to pick up many tumors that would probably never cause illness if left untreated.

For years, medical experts have vacillated between recommending and discouraging regular mammograms for women younger than 50. In 1997, a 13-member panel appointed by National Cancer Institute Director Richard Klausner weighed data from hundreds of papers and expert testimony, and concluded that routine mammograms for women younger than 50 provided no proven benefits. The same year, a National Institutes of Health panel issued similar guidelines, but its findings sparked a public backlash and were denounced in a unanimous Senate vote. In 2002, the USPSTF (with a different membership than the panel that produced the 2009 report) issued guidelines asserting that routine mammograms for women in their 40s were beneficial, although perhaps only slightly.

However, even as the mammogram was publicly championed as a means of reversing the documented rise in breast cancer, members of the medical community continued to question the effectiveness of the procedure.

The data seemed to show that breast cancer screening lowered breast cancer mortality rates. Some pointed out, however, that when age was factored in, the data showed better results only for women 50 and older.

feed women oversimplified messages, instead of communicating the more complex reality surrounding mammograms. Patients, supporters contend, should be armed with all the facts to decide for themselves whether to pursue routine mammograms earlier in life.

While some doctors tentatively backed the guidelines as a logical progression in evidence-based medicine, newspapers and opinion forums swarmed with personal accounts of breast cancer survivors who were able to overcome the disease because of early detection from screening during their 40s.

Researchers estimate that in the U.S. more than 192,000 women were diagnosed with breast cancer in 2009, and nearly 41,000 died from the disease. By providing X-rays of the breast, mammograms allow doctors to look for cancerous masses. Through mammograms, doctors can sometimes detect cancer years before it can be seen or felt.

Mammograms, especially in this age group, often lead to false positives, overdiagnosis and overtreatment.

Although false positives may lead to anxiety, emotional stress is a lesser evil than allowing young women to suffer and even die from breast cancer that could have been detected early enough to treat.