Nashville radiologist John Huff, MD, is passionate when it comes to preserving access to breast cancer screenings for women. The imaging director for Vanderbilt Breast Center, Huff also sits on the National Comprehensive Cancer Network consensus panel for breast cancer screening and diagnosis guidelines.

He worries that women and primary care providers could be confused by news coverage regarding the preferred schedule for mammograms. “The media has made it seem like there is a controversy,” said Huff, who is also a professor of Radiology at Vanderbilt University Medical Center. “In fact, the vast majority of professionals have stayed with the American Cancer Society (ACS) guidelines of annual mammograms for average-risk women beginning at 40 as they existed before the United States Preventive Services Task Force (report).” He added that even the U.S. Department of Health & Human Services rejected the task force suggestions in favor of ACS guidelines.

“What creates the impression of controversy is the public reporting of every new study. This often includes studies that may not be designed to answer the question, or studies based on different populations,” Huff stated. He noted that many of the reports seeking to change mammogram frequency are based on computer model studies from the national Surveillance, Epidemiology & End Results (SEER) data. However, he countered, “Few epidemiologists would replace guidelines based on randomized controlled trials with secondary computer modeling.”

Huff said it is unreasonable to expect patients … and even many providers … to understand the complexity of the epidemiological statistics. “There’s all of this complicated data with each study looking at only a small piece.” He added, “Primary care providers call me because they aren’t sure what to believe, and it is even more confusing for women. The media can do a lot of damage in these kinds of scenarios.”

While Huff said family history and breast density absolutely play a role in cancer risk, to personalize guidelines for each woman presumes that every individual has access to a provider. “Many women in this country do not have primary care providers,” he pointed out. In fact, he added, that is one of the reasons women are allowed to refer themselves for a screening mammogram without a provider’s order. “It’s one of the few imaging tests that you can get without an order.”

Pointing to the decline in death rates from breast cancer over the past several decades, Huff said clearly treatments have improved. However, he noted, before those protocols can be deployed, the cancer must first be detected. “Our best shot … as imperfect as our tools may be … is to find the cancers earlier,” he said.

“One out of six breast cancers is diagnosed in women in their 40s.” In fact, he continued, when these younger women do develop breast cancer, it typically happens in the prime of their professional and personal lives. For this reason, he noted, “Women in their 40s account for a disproportionate number of years lost to breast cancer.” He added the shorter sojourn time in younger women means the window to identify breast cancer at a more manageable stage is narrower for those under 50.

The bottom line, Huff concluded, is the best way to intervene early is to have annual mammograms beginning at 40 … and younger for those at higher risk … that allow radiologists to compare images over time. “We are able to detect those subtle changes and derive the greatest benefit when we perform quality mammography on an annual basis.”

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