Controversy over new mammogram guidelines

To say that the new guidelines for mammogram screenings presented by the US Preventive Services Task Force was a surprise reversal, which has also caused controversy, is an understatement.  The task force, which is made up of 16 health care experts, none of whom are oncologists, regularly advises insurance companies and government policy makers on matters of public health.

The new guidelines are:

1. No routine screenings for women aged 40-49 except those at high-risk for developing breast cancer (i.e. close family relations who had breast, colorectal, or prostate cancer; or tested positive for the BRCA1 or BRCA2 gene mutation)
2. Routine screenings for women aged 50-74 every two years, and
3. Discontinuation of teaching breast self-examination to patients or administering routine clinical breast examinations

The task force did not recommend other diagnostic tools as a replacement for women under age 50. Rather, they advised discussing the risks and benefits of mammogram screening with a doctor.

The American Cancer Society though is still abiding by the original recommendations made in 2002, which is for women over age 40 to have annual mammogram screenings.  "With its new recommendations, the (task force) is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them," said Dr. Otis Brawley, chief medical officer for the American Cancer Society.  Experts at the University of Texas M.D. Anderson Cancer Center also voiced concern and said they aren't changing their screening protocol.  "We disagree with their conclusions," Dr. Therese Bevers said of the task force. "You have to screen more women.  It's the value we put on zero women dying."

According to National Cancer Institute, breast cancer is the leading cause of cancer death in young women aged 15-54.  In addition, breast cancer accounts for 26% of all cancer in women aged 15-39 and 39% of all cancer in women aged 35-39.  In 2008, the American Cancer Society projected 182,460 new cases of breast cancer in women, with an estimated 10,000 of these women to be under age 40, and nearly 23,000 under age 45.

With that, there are just as many medical specialists who are in agreement with the task force that the risks to the general population of women being exposed to unnecessary radiation and biopsies outweighs the benefit to the relatively few young women who are diagnosed with breast cancer each year.  Dr. Susan Love, a renowned breast surgeon and activist, appeared on NBC Nightly News and said that this is "rationing of the best kind" and that "we are now in line with (the rest) of the world".

Related articles:
Reversing recommendation, women urged to begin mammogram screenings later
Breast cancer and young women
 

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