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