Panel: Screening Mammogram Guidelines Change
U.S. Preventive Services Task Force Recommends Routine Mammography Screening Every 2 Years
Nov. 16, 2009 – A government appointed expert panel is calling for huge
changes in breast cancer screening in the United States, but a leading cancer
group is highly critical of the move.
In newly revised guidelines, the U.S. Preventive Services Task Force
(USPSTF) now recommends against routine mammography screening for average-risk
women in their 40s.
USPSTF also says women between the ages of 50 and 74 should have mammogram
screenings every two years instead of every year.
Routine screening is not recommended for women older than 74.
In addition, the government task force:
- Concluded women and their doctors should base the decision to start
mammography before age 50 on the woman’s individual risks and preferences.
- Recommends against breast self-exams based on findings from two large
studies showing the practice to have no value.
- Concluded more evidence is needed to determine if clinical breast exams
performed by trained medical professionals are useful.
- Concluded more research is needed before recommendations for or against
mammography screening after age 74 can be made.
- Concluded there is not enough evidence to know if the newer digital
mammography or MRI are superior to traditional film mammography.
ACS Does Not Support Changes
The dramatically revised guidelines were based on a comprehensive analysis
of the research exploring the benefits and risks of breast cancer screening and
a risk-benefit model commissioned by USPSTF.
Task force vice-chairwoman Diana B. Petitti, MD, MPH, says the new
recommendations do not mean average-risk women younger than 50 and older than
74 should never be screened.
Rather, they are meant to foster discussion between these women and their
doctors about the risks vs. benefits of routine screening.
Potential risks include anxiety, unnecessary biopsy, and unnecessary
treatment of cancers that would never become life threatening.
"A woman who still wants to be screened after having the conversation with
her clinician and considering the balance of benefits and harms should
absolutely be screened," Pettiti tells WebMD.
The American Cancer Society will continue to recommend annual routine
mammography screening for all healthy women age 40 and over, ACS Chief Medical
Officer Otis Brawley, MD, confirmed in a statement issued today.
"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," he
Mammography Screening Every 2 Years
All agree that annual mammography screenings save lives.
But based on the research analysis and risk-assessment model, the task force
concluded the harms of telling women to have a mammogram every year starting at
age 40 outweigh the benefits.
According to the newly published research analysis:
- 1,904 women between the ages of 39 and 49 would need to be invited for
screening to have one breast cancer death prevented.
- 1,339 women between the ages of 50 and 59 would need to be invited for
screening to prevent one death.
- 377 women between the ages of 60 and 69 would need to be invited for
screening to prevent one death.