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New Mammography Guidelines Jolt Medical Field

Doctors Predict By-product of Screening Debate: More Talk With Patients About Mammograms
By
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 20, 2009 -- The new guidelines on breast cancer screening have instantly ignited an emotionally charged firestorm among doctors across the country.

“Physicians are quite divided about this," says Joseph Stubbs, MD, an Albany, Ga., internist and president of the American College of Physicians.

David Mutch, MD, a St. Louis ob-gyn, says the recommendations from the U.S. Preventive Services Task Force will not change his practice in any way. “It’s clearly economically driven and not patient care driven."

Other doctors have taken a step back to study the science. Julie Wood, MD, a Kansas City, Mo., family physician, says the new guidelines have led her to re-evaluate her practice patterns. She’s also looking for guidance from the American Academy of Family Physicians on the screening issue.   

There’s one thing, though, that doctors agree on: The new mammography advice will spark more discussions between women and their doctors about the benefits and risks of these screenings for the early detection of breast cancer.

Those talks have already begun, Wood says. “Patients have discussed it. They’re responding OK, but they’ve had a lot of questions.’’

Stubbs, meanwhile, predicts that the mammography advice will lead to an "evolutionary change" in medical practice. “I think there will be a decrease in the number of mammograms," he says. “But we won’t see a sharp drop-off."

Debate Over Screening Mammograms

The federally appointed task force released the new guidelines Monday. It recommends that women at average risk should wait to get routine screening mammograms until they’re age 50, instead of the current standard of 40. It also advises that women ages 50 to 74 get them every two years and discourages doctors from advising women to examine their own breasts regularly.

The guidelines, which are nonbinding, seek to reduce overtreatment. The downsides to screening include false-positives, radiation exposure, and psychological harm, the task force says.

“The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms," the task force says.

Leading medical groups, though, immediately announced their own guidelines had not changed. The American Cancer Society reiterated its guideline for annual screening mammography for all women beginning at age 40. The organization says it reviewed "virtually all the same data" that the task force scrutinized. “The lifesaving benefits of screening outweigh any potential harms,’’ says Otis Brawley, MD, chief medical officer for the American Cancer Society.

And the American College of Obstetricians and Gynecologists (ACOG) says it continues to recommend regular screening mammograms every one to two years for women in their 40s, annual screening for women 50 and older, and self-examination for breast cancer.

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