New Mammogram Guidelines
Posted 11/17/2009
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An announcement yesterday from the US Preventive Services Task force revising longstanding guidelines re mammograms has caused an uproar. Here is a brief summary from Dr. Susan Love's Blog (http://blog.dslrf.org/?p=113) :
The U.S. Preventive Services Task Force issued new guidelines on breast cancer screening today that do away with the "every woman should have an annual mammogram starting at age 40" recommendation women have long heard from their doctors.
The new recommendations are:
- Screening mammography should not be done routinely for all women age 40 to 49 years.
- Women and their doctors should base the decision to start mammography before age 50 on a woman's individual breast cancer risk and her understanding of the benefits and harms.
- Women age 50 to 74 years should have mammography every 2 years.
- More evidence is needed for the USPSTF to recommend for or against screening mammography after age 74 years.
This is clearly very different from what we have all been told for years. It is, however, not so different from what doctors have known and what the evidence has demonstrated. Mammograms are not as good a screening test in younger women as they are for post-menopausal women. The reason for this is the difference in breast tissue; dense tissue makes it more difficult to read the scans.
Personally, a mammogram never showed my first breast cancer when I was 44--even though there was a palpable lump. A mammogram twelve years later did find a new, small breast cancer. This experience is a good example of what can happen with mammograms--as in, sometimes they work and are really helpful, and sometimes they have no value.
Additionally, many European countries have long recommended that women receive mammograms every two years, not annually. Most breast cancer grow slowly, and this extra time is not likely to make a difference in survival.
Additional comments were:
- The USPSTF recommends against teaching patients breast self-examination.
- Available studies do not provide enough information to know whether breast examination by a trained medical professional adds bene?t beyond mammography.
- There is not enough information to know whether newer types of mammography (digital mammography) or magnetic resonance imaging are any better than regular ?lm mammography results.
Where does this leave us? (Other than confused and maybe upset). First, women who have had breast cancer are in a different group. The recommendations apply to screening tests for the general, healthy population. Our doctors will prefer that we continue with annual mammograms and, perhaps, breast MRIs.
These recommendations are in line with the evidence that exists. It is horribly distressing to be told that we really don't have very good screening exams for all women, that self-breast exams have not proven their value in reducing mortality. If we already felt out of control regarding this disease, this news probably makes us feel more so.
Take a deep breath and remember that nothing has changed for you. Talk to your doctors when next you see them about their recommendations for your annual tests. This is not a crisis, and there is no need to make phone calls. If you have an appointment for a mammogram scheduled before you see your doctor, go ahead and keep it.
And stay tuned. There is certain to be a lot of conversation about this and maybe, just maybe, this dialogue will eventually result in research that leads to better screening tests. That is the hope.
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