Why is there now a new recommendation that mammograms not be routinely performed until a woman turns 50? Undoubtedly, the reason is cost. Isn't it interesting that this recommendation comes out on the eve of passage of a Health Care Reform Act?
Women in Pennsylvania and those within the United States were surprised when recently the US Preventive Services Task Force (USPSTF) issued new breast cancer screening guidelines.
These new breast cancer screening guidelines recommended against routine mammography screening in women before the age of 50 years and ending screening at age of 74.
Women were understandably upset and outraged by these new guidelines which set forth a mere 24 year window in which women are screened on a every two year basis, (making that a 12 year window) for the detection of breast cancer, which is a well known and leading cause of cancer and morality in women. Notably these new guidelines are in opposition with other existing breast cancer screening guidelines from such well known and relied upon sources as the American Cancer Society and the American College of Radiology.
These new guidelines update and replace the 2002 USPSTF guidelines and currently recommend:
• Against routine screening mammography in women aged 40-49 years of age
• Women ages 50 to 74 should undergo screening mammography every two (2) years
• Currently the task force finds no proven benefit/risk of screening mammography in women over 74 years of age.
• Currently the task force has determined there is insufficient evidence of additional benefits/risks of clinical breast examination (as performed by your doctor during office exams) in women 40 years of age or older, and so are not recommending continuing these exams.
• The USPSTF recommends against doctors teaching women breast self examinations.
• The task force has determined no additional benefits or risks of either digital mammography or MRI as opposed to x-ray mammography as a screening tool.
The USPSTF based its new published guidelines upon published reviews of the efficacy of breast screening based upon x-ray (film) mammography, clinical breast exams, breast self exams, digital mammography and MRI and upon 2 studies performed at the request of the task force. The task force reviewed the benefits and risks of screening, the effect it has upon health care costs and the timing (every 1 or 2 years), onset (age to initiate screening) and duration (ending at age 74) of breast cancer screening.
The reviewers cite that for women ages 39-49 mammography screening was associated with a 15% decrease in breast cancer mortality rates. They noted however, that there is lack of screening data for women over the age of 70. Overall radiation exposure from mammography is considered to be low and was not noted to alter screening practices by doctors. Over-diagnosis from mammography screening was determined to be 1 to10 %. Younger women were noted to have more false positive mammography results requiring additional imaging but fewer biopsies. Breast self exams were determined to result in more benign biopsy results and were associated with no decreases in mortality rates and so they are recommending doctors no longer teach this screening exam to women.
As an effort to recognize women who may fall outside these guidelines the USPSTF notes that women ages 40-49 who are at high-risk for breast cancer are encouraged to consult with their doctors concerning when to begin screening mammography.
The results of this recommendation if followed could be devastating to women. Over the years, we have represented many women who have suffered from breast cancer, some of whose families have lost them due to a delay in diagnosis of their breast cancer.
As we know the earlier you detect cancer the better the chance of a cure. Many women will lose their opportunity for early breast cancer detection if these guidelines/recommendations are followed.
