Correcting a decade of negative news about mammography.

It's been ten years since the U.S. Preventive Services Task Force pulled back on recommendations for breast cancer screening in women ages 40 - 49 years. After a decade of negative reports, most physicians are aware of mammography's limits. Today, many women avoid, delay or deliberately skip getting screened. As invasive breast cancer rates have been rising, and breast cancer remains a leading cause of death, truthful information about screening is critical for public health. Unfortunately, many reports about mammography exaggerate its harms and over-estimate overdiagnosis. The public should be aware of current evidence supporting the benefit of breast cancer screening, including a 40% decline in the U.S. mortality rate in the mammography era. Delayed diagnosis has a downside, about which women should be informed. Contrary to popular views, breast cancer stage remains a key determinant of long-term prognosis. For the most common form of breast cancer, small tumor size and lack of lymph node involvement portend significantly better outcomes than larger tumors with positive nodes. Although mammography is not full-proof, the technology continues to improve; it is currently the best tool for finding breast cancer before it is greater than 2 centimeters or has spread. Interdisciplinary discussion of this topic by primary care physicians, oncologists, radiologists, public health experts, pathologists, and patient advocates would serve women's health.