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Confused About the Mammography Guidelines?
Content provided courtesy of the Vermont Cancer Center at the University of Vermont and Fletcher Allen.
In the face of new breast cancer screening guidelines advising women ages 40 to 49 against having annual mammograms, cancer centers across the country are rejecting the new recommendations. Instead, physicians are opting to stay the course with current recommendations, and not make any changes in what they advise to patients.
The recommendations, which were published in the November 17, 2009 issue of the Annals of Internal Medicine by the U.S. Preventive Services Task Force (USPSTF), a federal advisory panel of independent medical experts, redefine the current breast cancer screening guidelines created in 2002, advising against routine mammography screening in average-risk women under age 50, recommending biennial mammograms for women only between the ages of 50 and 74 years, and directing clinicians against teaching women how to perform breast self-examination.
The new USPSTF document also advises changing the mammography screening interval from 1 year to 2 years and suggests that women ages 40 to 49 who are at high risk for developing breast cancer consult with their primary care physician about the right time to begin regular, biennial mammography screening. The USPSTF also reported it did not find sufficient evidence to suggest that breast self-exams decrease the number of breast cancer deaths in women each year.
Sally Herschorn, M.D., UVM associate professor of radiology, director of breast imaging at Fletcher Allen, and Robert Oppenheimer, M.D., UVM professor of radiology object strongly to the new recommendations.
"We are definitely going to be telling our patients to continue with annual screening beginning at age 40 and to continue thereafter," Oppenheimer says. "I firmly believe that breast cancer screening with mammography has saved countless thousands and thousands of lives over the past 10 to 15 years, and to abandon this course of action would be unconscionable at this point."
Herschorn also expressed concern with the guidelines reversal, as they could greatly endanger the lives of many women and lead to disease being caught at later stages, when cancer is more deadly, she said. "Over the last 20 years the mortality from breast cancer has dropped by 30% after being stable for the 50 years before that," Herschorn says. "This drop is primarily related to the impact of screening mammography. I would hate to think of what would happen to breast cancer mortality in this country in the coming years if we followed these guidelines."
The second-leading cause of cancer death among women in the U.S., breast cancer affects one in every eight women in their lifetime, according to the American Cancer Society, an organization that has expressed strong criticism of the new recommendations.
The majority of cancer specialists and primary care physicians, as well as many of the estimated 250,000 breast cancer survivors in the U.S., readily attribute annual screening mammograms for identifying breast cancer early when it is most treatable. Widespread breast cancer screening in the U.S. combined with advances in therapies are generally recognized by cancer specialists and scientists as the single greatest factor in the dramatic reduction in breast cancer mortality seen since the current mammography guidelines were instituted in 2002.
"It's important to remember that for women between ages 40 and 50 there is a significant reduction in breast cancer mortality from screening and many of the studies demonstrating that reduction were done with annual mammography," says Vermont Cancer Center physician-scientist Marie Wood, M.D., UVM professor of medicine and interim director of the Division of Hematology/Oncology at Fletcher Allen. "For women 40 and 50, both the false positive and false negative rates are higher, so to screen based on risk makes sense, but we need more studies to determine how to best do this. For now, women between ages 40 and 50 should work with their primary care providers to assess their risk as not all women in this age group have the same risk for breast cancer."
In response to the new USPSTF recommendations, the National Cancer Institute (NCI) issued a statement underscoring that it will review the new USPSTF recommendations before making any corresponding recommendations regarding breast cancer screening in light of the task force panel’s recent assessment. "Screening mammography remains an important, effective tool for early detection of breast cancer," the statement said.
Additionally, U.S. Health and Human Services Secretary Kathleen Sebelius issued a statement on the new breast cancer screening recommendations. "What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect, and fight breast cancer," Sebelius said. "My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you."
The new USPSTF guidelines are available online at the Annals of Internal Medicine.