Panel Blasts Mammogram Guidelines
Radiologists: Breast Screenings Should Continue to Begin at Age 40
Dec. 2, 2009 (Chicago) -- A panel of breast cancer screening experts today
blasted new government guidelines that recommend against routine annual
"The net effect of the new guidelines is that screening would begin too late
and its effects would be too little. We would save money, but lose lives," says
Stephen Feig, MD, professor of radiology at the University of California at
Irvine and president-elect of the American Society of Breast Imaging.
Feig and other panel members were reacting to newly revised guidelines from
the U.S. Preventive Services Task Force (USPSTF) that recommend 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.
Breast Guidelines Wipe Out Years of Progress
The breast screening panel says the guidelines would represent a major
setback, wiping out decades of progress.
"Deaths from breast cancer have dropped by 30% since 1990, when mammography
screening beginning at age 40 became more widespread," says Daniel B. Kopans,
MD, professor of radiology at Harvard Medical School.
He says the task force relied on studies with methodology flaws that
underestimated the benefits of mammography.
"Numerous [well-designed] studies have proven the benefits of annual
mammograms beginning at age 40," Kopans says.
"The guidelines tell women in their 40s that they can go back to the 1950s
when they had to wait until a tumor was too large to ignore, and then go to the
doctor when there was no longer any chance of a cure," Kopans says.
Breast Screens' Benefits Outweigh Risks
Feig also took issue with USPSTF's reasoning that for younger women, annual
mammograms carry a risk of harm, chiefly anxiety and false positives, that
could outweigh their benefits.
"Think of a smoke detector. Do you want it to go off only when the house is
half burned down or put up with the fact that it will sometimes go off when
there is smoke in the kitchen?
"You’re going to have some false positives, if you detect cancer early,"
when it is most curable, Feig says.
The panel spoke here at the annual meeting of the Radiological Society of
Advice for Women
The breast screening panel supports American Cancer Society (ACS)
guidelines, which continue to recommend annual routine mammography screening
for all healthy women age 40 and older.
"The ACS guidelines have been shown to save lives. The USPSTF admits its
guidelines will cause women to die," Kopans says.
No Breast Screening Experts on Task Force
Kopans says he believes the government panel had "good intentions. They just
didn't know a lot about breast cancer screening," he says.
He notes that there were no radiologists -- the very doctors that perform
mammograms -- on the USPSTF task force.
A big worry, the panel says, is that the USPSTF's recommendations will be
used by any possible health plan being considered in Congress. That, in turn,
would lead insurance companies to stop covering the annual breast cancer
screenings beginning at age 40, it says.