Sunday, November 22, 2009

Mammogram Screening For Breast Cancer: No Mammograms until Age 50? New Task Force Recommendations.

The current mammogram screening recommendation put forward by the American Cancer Society is for yearly mammograms for all women aged 40 years and older. Women with a strong family history of breast cancer are urged to start mammogram screening from the age of 35.

The U.S. Preventive Services Task Force (USPSTF), a government-appointed expert panel, recently made new recommendations for mammogram screening for breast cancer:

  • Women between 40 and 49 years old should not be having routine screening mammograms.  Instead, they say that women should make an informed decision about screening mammography before 50, and weigh their potential risks and benefits with their doctors.
  • Women who are 50 to 74 years old should be having a screening mammogram every other year (not yearly), because the risk for breast cancer increases as you age. 
  • Women over 74 years old are not given specific guidelines about routine screening mammography - as their risk of death from heart disease and other ailments is greater than from breast cancer.
  • Women of any age should not be taught to do breast self-exams, but breast self-examination is not forbidden.
  • Clinical breast exams (CBE) will not be required before screening mammograms, because CBE appears to add no benefit to the information gained from a mammogram.
In case you're interested, here are Task Force recommendations on the USPSTF website.

So what does this all mean? Basically, the Task Force is recommending women delay screening mammograms until age 50 in most instances. They say that there's no value in doing breast self-exams and that clinical breast exams don't make any difference either. Also, your breast health could go completely unchecked for years, even though risk for breast cancer increases as you age.

According to Dr. Susan Love, a renowned breast surgeon and activist, "this is rationing of the best kind" since the guidelines were based on scientific data.  However, the data that was considered by the task force was from 2002 - digital mammography has become more accurate since then.

The timing of these recommendations is interesting to me, just when the health care debate is firing up. Any Government health initiative like the "Public Option" for instance, will surely be using these federal guidelines rather than the American Cancer Society guidelines. This feels a little too much like cost-cutting, especially when you consider that since the onset of regular mammogram screening in 1990, the death rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.

I also heard Dr Love mention in an interview that mammograms aren't very good. A lot of cancers are missed. I agree with that. Mammograms can miss up to 20% of breast lesions. But for $125 that's the best we have right now. I'm all for doing away with mammograms but only if we have something better to replace them with. Right now, that's MRI but obviously no-one is advocating yearly screening MRIs, primarily because of the huge cost that would incur.

Dr Love also said that "all bets are off" if a woman feels a lump.... "she should seek medical advice immediately". How is a woman going to feel a lump when all of a sudden these guidelines are telling doctors NOT to teach women how to perform a breast exam? If that's not a contradiction, what is? We've spent decades educating women and the public to perform this early detection and now we've just  done a complete 180.

One of the bodies the task force has certainly influenced over the years is the insurance industry. These recommendations may provide the reason for some private insurance companies to cut back coverage for annual screenings, particularly for young women. I can hear it now... "the task force doesn't support mammogram screening so we're not going to pay for it."

In the end, women need to remember one very important fact: breast cancer kills more than 40,000 women each year. I would recommend you don't treat these guidelines as gospel and for you to be your own health care advocate. Discuss the benefits and risks of a mammogram, ultrasound, clinical breast exam and breast self-exam with your own doctor.

If you're against these recommendations you have the opportunity to make your voice heard. By signing this petition you'll be encouraging governing bodies and key medical institutions to keep the present mammogram screening guidelines.


Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction and scar healing. Keep up to date with the latest news in breast cancer reconstruction at The Breast Cancer Reconstruction Blog. Also join us on Facebook and Twitter!


1 comment:

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