The question continues as to when breast screening should begin. The current pushback comes from radiologists Dr. Mark Helvie of the University of Michigan Health System and colleague Dr. Edward Hendrick of the University of Colorado.
The two researchers have published an article (full reference below) in the February issue of the American Journal of Roentgenology questioning the U.S. advisory panel’s breast cancer screening guidelines and suggesting the panel ignored scientific evidence that more frequent mammograms save lives.
For the article, the two conducted a review of the risk models used by the U.S. Preventive Services Task Force (USPSTF) to issue controversial breast screening guidelines in 2009. They used Cancer Intervention and Surveillance Modeling Network modeling to compare lives saved by different screening scenarios and the summary of evidence prepared for the USPSTF to estimate the frequency of harms of screening mammography by age.
As a reminder, the USPSTF 2009 breast screening guidelines recommend:
- The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. (Grade: B recommendation)
- 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. (Grade: C recommendation)
- The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (Grade: I Statement)
- The USPSTF recommends against teaching breast self-examination (BSE). (Grade: D recommendation)
- The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. (Grade: I Statement)
- The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer. (Grade: I Statement)
Helvie and Hendrick analysis found that having annual mammograms from age 40 saved 64,889 more lives with the current 65% compliance rate.
They found that getting a yearly mammogram from age 40 cut a woman’s risk of fatal breast cancer by 71% versus the 23% reduction for women who followed the USPSTF recommendations.
The two researchers state, “The potential harms of a screening examination in women 40–49 years old, on average, consist of the risk of a recall for diagnostic workup every 12 years, a negative biopsy every 149 years, a missed breast cancer every 1,000 years, and a fatal radiation-induced breast cancer every 76,000–97,000 years.”
The two researchers feel the advantages of yearly mammograms starting at age 40 years outweighs the potential harms of screening.
I think perhaps they should read Dr. Marya Zilberberg’s, Healthcare, etc, post: Why medical testing is never a simple decision
……..So, going back to the 10,000 women we are screening, of 9,900 who do NOT have cancer (remember that only 100 can have a true cancer), 10%, or 990 individuals, will still be diagnosed as having cancer. So, tallying up all of the positive mammograms, we are now faced with 1,070 women diagnosed with breast cancer. But of course, of these women only 80 actually have the cancer, so what's the deal? ……….
Screening Mammogram Recommendations (January 7, 2010)
The New Mammogram Guidelines - What You Need to Know (December 27, 2009; TBTAM)
Hendrick, R. Edward, Helvie, Mark A.; United States Preventive Services Task Force Screening Mammography Recommendations: Science Ignored; Am. J. Roentgenol. 2011 196: W112-116