By now the news of the new breast cancer screening guidelines issued by the U.S.Preventive Services Task Force* is out and sides have been chosen. Several prominent breast cancer organizations have come out for the guidelines, while several others are outraged.
So what are the recommendations exactly?
From the U.S. Department of Health and Human Services, USPSTF Press Release:
-Women 40-49 should not have routine mammograms
-Regular mammography screening should start at age 50 and occur every two years until age 74.
-Regular biennial exams for women under 50 should be made on a case by case basis, depending on the individual and should take into account the patient’s full understanding of the specific risks and benefits
-more research is necessary for the USPSTF to make recommendations for or against regular screening for women over 75
The task force also:
-Recommended AGAINST teaching breast self-exams (BSE)
-Said there is insufficient evidence to assess the additional risks or benefits of clinical breast exams beyond mammography screening in women over 40
- Said there is insufficient evidence to assess the additional risks or benefits of either digital mammography or MRI over film mammography as screening tools for breast cancer.
Created in 1984, the USPSTF is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. Their recommendations are considered the “gold standard” and are likely to be widely adopted, and thus have a huge impact on what patients and doctors know and understand about breast cancer detection.
Organizations that support the new guidelines:
National Breast Cancer Coalition:
“For years, NBCC has told the public the difficult truth about the limitations and risks of breast cancer screening, both for mammography and breast self examination. The United States Preventive Services Task Force (USPSTF) today has released revised guidelines that, in part, reflect our long-held position on screening.”
Dr. Susan Love Research Foundation:
“…we need to do help women understand what mammography can and cannot do, and focus on finding the cause of breast cancer and preventing it altogether. I don’t want women going for mammograms they don’t need, or feeling I false sense of security because they have had one. I want them to have the opportunity to take part in the research that we need to go beyond a cure!”
Organizations against the new guidelines:
“At Breastcancer.org, we are deeply troubled by both the analysis that led to these proposed guideline changes and the effect these proposed changes would have on the health and lives of women. Our specific concerns:
- The analysis was based on older mammography techniques, meaning the researchers mostly looked at results from film mammograms instead of digital mammograms.
- The analysis was based on some inaccurate assumptions about optimal treatment after breast cancer is diagnosed.
- The analysis did not adequately consider the combined benefit of early detection (with current screening guidelines) and new treatments that have resulted in steadily improving survival rates in recent years. Screening cannot be looked at in isolation as a snapshot. Screening happens as we continue to improve both diagnosis and treatment. But we can’t treat what isn’t diagnosed.
- The proposed guideline changes would mean that many breast cancers would be diagnosed at a later stage, making it harder to become cancer-free.
- The proposed guideline changes would mean that younger women would be diagnosed later. “
“The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.”
Susan G. Komen for the Cure:
"Susan G. Komen for the Cure wants to eliminate any impediments to regular mammography screening for women age 40 and older. While there is no question that mammograms save lives for women over 50 and women 40-49, there is enough uncertainty about the age at which mammography should begin and the frequency of screening that we would not want to see a change in policy for screening mammography at this time." Komen's current screening guidelines.
American College of Obstetricians and Gynecologists (ACOG):
"The American College of Obstetricians and Gynecologists, however, currently continues to recommend the following services:
• Screening mammography every 1-2 years for women aged 40-49 years
• Screening mammography every year for women age 50 or older
• BSE; BSE has the potential to detect palpable breast cancer and can be recommended."
The College is continuing to evaluate in detail the new USPSTF recommendations and the new evidence considered by the USPSTF. Any changes to College guidance will be published in its journal Obstetrics & Gynecology.
We want to know what you think of the new guidelines. Do you have questions? Comments? Concerns? Let us know how we can help you navigate these new guidelines.
Over the next few days we plan to bring you more commentary from our experts, from the web, and from doctors about how, exactly, these new guidelines will impact you or the women in your lives.
Update #1: Kathleen Sebelius, HHS Secretary: "http://www.healthcentral.com/breast-cancer/c/78/95453/recommendations."
Update #2: BreastCancer.org has a petition to change the new BC screening guidelines
Phyllis Johnson: Risks and Benefits: Understanding the Statistics that Affect You
Maimah Karmo: The "Gods" Must Be Crazy
Published On: November 17, 2009