Panel Blasts Mammogram Guidelines

Radiologists: Breast Screenings Should Continue to Begin at Age 40

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Dec. 2, 2009 (Chicago) -- A panel of breast cancer screening experts today blasted new government guidelines that recommend against routine annual mammograms.

"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 North America.

Continued

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.

USPSTF Says Its Message Could Have Been Better Communicated

Meanwhile at a House Energy and Commerce Subcommittee on Health hearing in Washington today, Diana Petitti, MD, MPH, vice chair of the USPSTF, acknowledged that "the expertise of this panel has been called into question."

But, she adds, radiologists were "consulted and reviewed the recommendations and provided input."

Petitti and another member of the Task Force told the hearing that their message could have been better communicated and that and it wasn't saying women under 50 shouldn't have mammograms.

The Task Force wanted to convey that women should still talk with their doctors and let young women know that for them, the risks of mammography may outweigh the benefits, Petitti said.

WebMD Health News Reviewed by Louise Chang, MD on December 02, 2009

Sources

SOURCES:

95th Annual Meeting of the Radiological Society of North America, Nov. 29-Dec. 4, 2009, Chicago.

Stephen Feig, MD, professor of radiology, University of California at Irvine; president-elect , American Society of Breast Imaging.

Daniel B. Kopans, MD, professor of radiology, Harvard Medical School.

Diana Petitti, MD, MPH, vice chair, USPSTF.

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