Five reasons to hail new breast cancer screening guidelines

The medical advisory about-face on regular mammograms set off alarms of skepticism and fear last week, especially among women in the Bay Area where the breast cancer rate is the highest in the country. News coverage, blogs, and opinion pieces echo an increasingly pervasive suspicion, heightened by health care reform politics, that cost supersedes care. However, the report published by the U.S. Preventive Services Task Force and media coverage of the findings failed to fully explain the research and analysis behind the recommendations, which might have allayed some fears. This Whole Health Science five-part series explores the scientific fact and statistics behind the new guideline.

Fact: It's good news (which has nothing to do with cost or coverage).

Despite conflicting research on the effectiveness of mammograms in saving lives, insurance companies, government agencies, medical groups, and doctors have been urging women to have regular mammograms – and specifically since the 1980s, once every one to two years for women starting at age 40. However, the new breast cancer guidelines recommend against regular screening for women in the 40-49 age group. Instead, they now advise that level of consistency only for women older than 50 and even then every two years instead of every year.

“This is a complete pendulum swing away from what doctors and science have told women is in their best interest,” according to Dr. Sara Gottfried, integrative gynecologist and director of the Gottfried Center for Integrative Medicine in Oakland. “Women have been listening for years to medical advice that they suddenly learn is wrong, and now they need to know why they are safe if they follow the new guidelines.”

The good news, according to Dr. Gottfried, is that for the first time since research began on the effectiveness of mammograms in 1963, women who are suspicious of how mammograms have been oversold now have evidence on their side to support less frequent screening.

“Even though research never concluded that mammograms keep them safe and even though they worried about the risks of repeated exposure to radiation, many women followed established recommendations simply because they were considered irresponsible or negligent if they didn’t,” said Dr. Gottfried.

 

Patients have had reason to be concerned about the potential harm of annual mammograms: according to the Task Force, more than half of women ages 40 to 49 would have a false-positive mammogram during a decade of annual screening, leading to additional X-rays and biopsies.

 

“This has become such a political issue, so it’s doubtful insurance companies are going to stop paying for mammograms,” said Gottfried. “But now, with these guidelines, women will be able to decide how often and when, and that’s the perfect outcome.”

Upcoming fact-finding reports will explore why the changes target the 40-49 age group; reliability of breast cancer screening; a stunning – and to many, welcomed –  reversal on breast self-exams, and the historical sources of breast cancer research and recommendations.