Tuesday, November 17, 2009

New Breast Cancer Screening Guidelines

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Yesterday,  the U.S. Preventive Services Task Force’s announced it’s new recommendations for Screening for Breast Cancer (November 2009).  The uproar has been loud and mostly against. 
The summary of the USPSTF’s recommendations:
  • Recommends against routine screening mammography in women aged 40 to 49 years. 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.
  • Recommends biennial screening mammography for women aged 50 to 74 years.
  • Concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
  • Recommends against teaching breast self-examination (BSE).
  • 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.
  • 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.
If you recall some of the recent discussions regarding over-diagnosis  of breast cancers and the resulting harm done by the increased radiation, biopsies, and surgeries then it is easier to understand the task forces conclusions.  There has been an estimated 52% over-diagnosis of breast cancer in a populations of women who are offered organized mammography screening.  That amounts to one in three breast cancers being over diagnosed.
My personal feeling is that anyone with a family history of breast cancer should begin getting mammograms at 10 years earlier than the age when their mother was diagnosed with breast cancer.  There will always be “outliers” like the 10 year girl diagnosed with breast cancer. 
I do not agree with not teaching breast self-examination.  I think every woman/man should be familiar with their bodies.

Here are links to some of the responses to the USPSTF’s recommendations.  Some of the comments are as enlightening as the stories.
  • Response of The American College of Obstetricians and Gynecologists to New Breast Cancer Screening Recommendations from the U.S. Preventive Services Task Force, November 16, 2009
  • M. D. Anderson Maintains Mammogram Recommendations, November 16, 2009
  • Will patients accept the new, evidence-based, breast cancer screening guidelines? by KevinMD, November 17, 2009
  • Does number needed to treat help with rational decision-making? by Marya Zilberberg, November 17, 2009
  • Panel Puts Off Mammography until Age 50; MedPageToday, November 16, 2009
  • Mammography Screening: Are the New Guidelines Rationing by Dr Susan Love, November 16, 2009
  • USA TODAY Forum: Breast cancer survivors sound off on new mammogram advice, moderated by @LizSzabo
  • Susan G. Komen for the Cure® Recommends No Impediments to Breast Cancer Screening, November 16, 2009
  • Breast Self-Examinations: What’s Wrong With Them? by Shirley S. Wang; Wall Street Journal Blog; November 16, 2009
  • Breast-Screening Advice Is Upended by Shirley S. Wang, Wall Street Journal, November 17, 2009


Chrystal K. said...

I hope these revisions are a step in the right direction.

Dr. Smak said...

Great review, Ramona. Thanks for the links.