New Mammogram Guidelines: How many deaths are enough?
Seventeen percent of deaths from breast cancer occur in women who are diagnosed in their 40s. The American Cancer Society estimates that in 2009 there will be 192,370 new cases of invasive breast cancer in the United States, causing 40,170 deaths. That’s a lot of deaths, and no one is disputing that early detection is our best weapon.
Yet, flying in the face of everything we’ve heard for the last several decades, the word from the U.S. Preventive Services Task Force report released earlier this week is that here is no benefit to performing breast self-exams. Unless you are in a high risk group, you can wait until you are 50-years old before getting your baseline mammogram, and then repeat only every other year.
The USPSTF also recommends against teaching breast self-examination. You can read the full text of the documents HERE.
According to the panel, younger women have little to gain from mammogram screening — the 10-year breast cancer risk for a 40-year-old is only 1.4 percent. They also point to the risk of younger women being harmed from false positives that cause needless worry, additional tests and biopsies, pain, and expense.
Just how the new recommendations will affect insurance coverage for mammograms remains to be seen, but I suspect it won’t help matters.
The American Cancer Society does not intend to change its guidelines and responded to the USPSTF report with a statement from Otis W. Braley, M.D., chief medical officer of the American Cancer Society that reads, in part:
“The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.
“With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them. The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening. The most recent data show us that approximately 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s, and 22 percent occurred in women diagnosed in their 50s. Breast cancer is a serious health problem facing adult women, and mammography is part of our solution beginning at age 40 for average risk women.” (emphasis mine) You can read the complete statement HERE.
The Susan G. Komen for the Cure® also released a statement which read, in part:
“Susan G. Komen for the Cure wants to eliminate any impediments to regular mammography screening for women age 40 and older. While there is no question that mammograms save lives for women over 50 and women 40–49, there is enough uncertainty about the age at which mammography should begin and the frequency of screening that we would not want to see a change in policy for screening mammography at this time.” Komen’s current screening guidelines can be found at www.komen.org.
We encourage women to be aware of their breast health, understand their risks, and continue to follow existing recommendations for routine screenings including mammography beginning at age 40.” (emphasis mine) You can read the complete statement HERE.
Health and Human Services Secretary Kathleen Sebelius released a statement on Wednesday saying, in part:
“My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer, and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you.” On the question of insurance, she said that the doctors and scientists on the task force “do not set federal policy and they don’t determine what services are covered by the federal government.” You can read her statement in its entirety HERE.
Perhaps the USPSTF does not set policy, but insurers are always looking for ways to cut costs and we’ve just given them a sweet opening.
So what’s a woman to do amidst such conflicting advice? If seventeen percent of deaths from breast cancer occur in women who are diagnosed in their 40s, I can’t help but wonder… how many deaths is enough to make screening worthwhile?
The news this week has been saturated with heated debate on the topic. The ACS saw an 18 percent increase in phone calls in the days following the release of the report.
Many people agree that mammograms are over-used and often unnecessary and are thrilled to finally have confirmation but others, particularly women who are breast cancer survivors, are outraged. A quick search on the micro-blogging site Twitter comes up with words like “irate,” “angry”, “shocked,” and “hate,” leading some to make impromptu donations to cancer organizations.
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Photo: U.S. Centers for Disease Control