In case you missed it during last night’s newscasts or this morning’s talk shows, the U.S. Preventive Services Task Force has made a huge about-face with its breast cancer screening recommendations.
Based on the latest string of studies (which I’ve posted about frequently, for example, here), this independent panel of prevention and primary-care experts now recommends the following:
- Women should start having screening mammograms at age 50 rather than at age 40.
- Women between the ages of 50 and 74 should have mammograms every two years rather than once a year. (The task force says current evidence is insufficient to determine whether the benefits of screening mammography outweigh the potential harms for women aged 75 and older.)
- Doctors should stop instructing women to conduct regular breast self-exams. (The task force said that there’s insufficient evidence to know whether clinical breast exams — those done by doctors — were beneficial.)
(These recommendations are not, however, for high-risk women — those with a strong family history of the disease, for example.)
Writes the New York Times:
Dr. Diana Petitti, vice chairwoman of the task force and a professor of biomedical informatics at Arizona State University, said the guidelines were based on new data and analyses and were aimed at reducing the potential harm from overscreening.
While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.
Dr. Petitti also told the Times that although she knew the new guidelines would be a shock for many women, “we have to say what we see based on the science and the data.”
According to the Times, the National Cancer Institute is now considering revising its breast-cancer screening guidelines as well. But the American Cancer Society, the American College of Radiology, and (according to Bloomberg News), the American College of Obstetricians and Gynecologists have announced their intention to continue to recommend annual mammograms starting at age 40.
UPDATE: On Tuesday, the Mayo Clinic in Rochester announced that it will not be changing its screening recommendations, but will be sticking with its current ones, which encourage women to get annual mammograms starting at age 40. Mayo also intends to continue to promote both breast self exams and annual clinical exams.
Right now, it’s unclear how these new guidelines will affect insurance reimbursements for mammograms. Some people (I heard it being discussed on MSNBC this morning) are already charging that this change in recommendations is being done more to control health care costs than to improve health.
Those people, I politely suggest, haven’t really examined the research. Nor, I think, have they considered that all the money spent on unnecessary mammograms (and the often resulting unnecessary biopsies and treatment) could be much better allocated. As the women’s health advocate (and long-time believer in a more evidence-based approach to mammography) Dr. Susan Love blogged yesterday: “We need to help women understand what mammography can and cannot do, and focus on finding the cause of breast cancer and preventing it altogether.”
The new guidelines were published in the Annals of Internal Medicine, which you can read in full here.