By Calvin Palmer
An influential committee today recommended new guidelines for breast cancer screening, advocating that women should start regular screening at the age of 50 and not 40.
The United States Preventive Services Task Force, which provides guidance to doctors, insurance companies and policy makers, also says women aged 50 to 74 should have mammograms every two years rather than annually.
It also said doctors should stop teaching women to examine their breasts on a regular basis.
Dr Diana Petitti, vice chairwoman of the task force, said the guidelines announced today were based on new data and were aimed at reducing the potential harm from overscreening.
Several patient advocacy groups and many breast cancer experts welcomed the announcement. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies, and unneeded treatment, including surgery, radiation and chemotherapy.
But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.
“Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it,” said Daniel B. Kopans, a professor of radiology at Harvard Medical School. “It’s crazy — unethical, really.”
The chief medical officer of the American Cancer Society, Dr Otis W. Brawley, said in a statement that mammography had risks as well as benefits but, he said, the society’s experts had looked at “virtually all” the task force and additional data and concluded that the benefits of annual mammograms starting at age 40 outweighed the risks.
The National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network, welcomed the new guidelines.
President of the National Breast Cancer Coalition Fran Visco said: “This is our opportunity to look beyond emotions. The task force is an independent body of experts that took an objective look at the data. These are the people we should be listening to when it comes to public health messages.”
The new guidelines were based on a comprehensive analysis of the medical literature, including an update of a Swedish study involving some 70,000 women, new results from a British trial involving more than 160,000 women and data from more than 600,000 women from the U.S. Breast Cancer Surveillance Consortium.
In addition, the task force commissioned an unusual study funded by the National Cancer Institute that involved six independent teams of researchers conducting separate mathematical modeling studies of the risks and benefits of 20 different screening strategies.
While annual mammography for all women beginning at age 40 reduced the death rate from breast cancer by at least 15 percent, the modeling studies indicated that the added benefit of starting before age 50 was modest, the researchers concluded.
For every 1,000 women screened beginning at age 40, the modeling suggested that just 0.7 deaths from breast cancer would be prevented, while 480 women would get a false-positive result and 33 more would undergo unnecessary biopsies.
“What isn’t in the model but is an issue is how many extra imaging tests are done to follow up on things that turn out to be falsely positive, and the harm of the anxiety that goes along with that,” Petitti said. “Then there’s the whole other line of problems that come into play, which is where there are some breast cancers detected that grow very slowly and would never have killed you.”
Cutting back to biannual screening of women age 50 and older would maintain 81 percent of the benefits of screening annually while reducing by half the number of false-positives, the computer modeling study estimated.
Petitti stressed that the task force is not recommending against mammography but hopes the new guidelines will lead more women to make their decisions individually. Those at high risk because of a family history of breast cancer, for example, or those who are simply more worried about breast cancer might still opt to get annual screenings, she said.
While the task force recommended against doctors teaching women how to perform regular breast self-exams and concluded that there was insufficient evidence to determine whether doctors’ examinations of a woman’s breasts are beneficial, several experts stressed that women should seek medical attention if they come across any unusual lumps spontaneously.
Dr Donald A. Berry, a statistician at the University of Texas M.D. Anderson Cancer Center and head of one of the modeling groups said that if the new guidelines are followed, billions of dollars will be saved.
“This decision is a no-brainer,” he said. “The economy benefits, but women are the major beneficiaries.”
It will be interesting to see what political capital is made from this announcement in the next few days. It kind of puts the Tea Bags between a rock and a hard place. They are in favor of cutting out waste but their constituency also includes many of the medical profession whose earnings are bound to take a hit if fewer mammograms are conducted.
The Tea Bags are against “big government” but seem to favor doctors making big bucks at our expense.
It always strikes me how so many doctors in America are from Third World countries, rather than bring healing to their own countries where it is most needed, they seem to prefer to gravitate to the United States. Is it because their powers of healing can have greater effect in the United States or because they stand to earn themselves a lot of money?
I always thought the Hippocratic oath was about saving lives, rather than amassing huge personal fortunes.