Task Force and American Cancer Society clash on new mammography guidelines

Today’s Annals of Internal Medicine updates the 2002 US Preventive Services Task Force (USPTF) recommendations for routine mammography for women and already there has been an outcry from the American Cancer Society (ACS).

Instead of starting regular screening at age 40, the new guidelines call for waiting until age 50. Those women between the ages of 40 and 49 who are at high risk for breast cancer are advised to ask their personal physician when they should have their first mammogram and at what intervals.

For those women not at high risk, the USPSTF now recommends changing intervals between mammograms from 1 to 2 years until the age of 74. Because members of the Task Force did not find enough published evidence to determine the benefits versus potential harm for women over aged 75, they made no recommendations for women over 75 to be screened routinely.

In another dramatic departure from what had been conventional wisdom for decades, the USPSTF now recommends against teaching self-breast exam, claiming that the technique has not been shown to reduce breast cancer mortality.

ACS leaders were quick to disagree with these recommendations. Otis W. Brawley, MD, Chief Medical Officer, American Cancer Society (ACS), told the Doctor’s Guide that, "As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: this is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member."

In making its new recommendations, the USPSTF reviewed published research, analyzing the effectiveness of five different screening techniques in reducing deaths from breast cancer. These included film mammography, digital mammography, breast examination by a doctor, breast self-examination, and magnetic resonance imaging (MRI). The Task Force also commissioned two analytical studies related to breast cancer screening: a targeted systematic evidence review of six selected questions relating to the benefits and harms of screening; and a decision analysis that used population modeling techniques to compare expected health outcomes and resource  requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.

According to Dr. Brawley, in 2003 an ACS expert panel reviewed data that was similar to the data analyzed by the Task Force, but came to a very different conclusion. Unlike the USPSTF. the ACS panel did find convincing evidence that screening mammography in women starting at age 40 reduces breast cancer mortality. "We specifically noted that the overall effectiveness of mammography increases with increasing age. But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives."

Clearly there will be much discussion by health professionals in the coming weeks as to which recommendations to consider as the best standard of care. Women will need to pay attention to the debate and talk to their own physicians about what is best for them.

For more information on the breast cancer screening recommendations from the USPSTF