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New Mammogram Guidelines: How many deaths are enough?

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.

The state of women’s health care is already overly-complicated and riddled with added fees for premiums, co-pays, and out-of-pocket expenses. Now there’s one more maze to cut through.

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71 comments

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7:28AM PST on Dec 11, 2013

Does anyone know who this task force is anyway? Who sits on it and what are their qualifications? Exs. from the insurance companies? One wonders. Please tell us who they are. Thank you. And no, I didn't see anything I want to sign on to as one of their recommendations. I'm old fashioned, I want to make my own decisions with some input from a good doctor that I trust.

6:20AM PST on Nov 25, 2009

How many of the 40,00+ deaths are caused by mammography itself?

A safer and more accurate way to test for breast is thermograpy, as there is no radiation.

7:39AM PST on Nov 24, 2009

very important article-thank you

6:53PM PST on Nov 23, 2009

Does anyone else find susan o's comment about "genocide" and coming "out swinging, wearing full body armor and packing an AK47" quite telling about the real intent behind this faux-outrage at the 'new' recommendations?

This is just more fear and bluster from those who claim health care reform will cause 'rationing'. This is not "rationing", and these recommendations aren't even new.

6:42PM PST on Nov 23, 2009

Thank you, Pa H. It's nice to see someone who has the facts amid all this smoke and mirrors.

this isn't "Rationed Care". That is political spin.

5:42AM PST on Nov 23, 2009

The National Breast Cancer Coalition has shared this position for years. The truth is that in the 40-49 age group mammographies do not make a difference in survival rate.

It has never been the position of the group that women should not have mammography, just that the limitations of mammography should be recognized and as a policy issue the money spent on advocating for mammography could be better spent.

The truth is that the tumors most often detected by mammography are slow growth tumors, it misses the more lethal and fast growing cancers. So when the interval of detection is not looked at, there is no difference in survival between women having a mammography and those who do not

In other words women who had mammographies did not live longer than those who did not. Also women in the 40-49 age group have more dense breast tissue which makes it more difficult for the test to be effective.

In regards to the monthly BSE what the research found is that women most often find lumps during a shower, or their partner locates it, it does not happen during the monthly BSE.

For greater clarification on this issue please visit the National Breast Cancer Coalition's web site.

http://www.stopbreastcancer.org/index.php?option=com_content&task=view&id=978&Itemid=179

3:54PM PST on Nov 22, 2009

We need to stop mamograms if we so choose and allow Tomagraphy or Ultra sound as mammograms are causing cancers in women...time for Medicare & the insurance companies to stop telling us what we can or can't have and allow us to decide what we feel is in our own best interest. Tired of too many x rays and radiation in testng that can be done in a safer manner.

1:07PM PST on Nov 22, 2009

Maria DeLuca asks who produced the new mammography guidelines.
It was the National Cancer Institute, part of the National Institutes of Health, US government. It was NOT the insurance industry. The scientists at NCI are non-partisan and include epidemiologists, statisticians, and physicians. Their goal is to recommend the optimal screening schedule for the general population - the goal is to reduce risks from overscreening incl. exposure to radiation and unnecessary surgery and yet find small and slow-growing tumors in time to treat. Fast growing tumors are more likely to be detected by the woman herself in any case.

12:42AM PST on Nov 22, 2009

it's interesting that Medicare won't pay for Thermography or Ultrasound, but will pay for mammograms. If men had to have their testicles squeezed between two heavy, radiation-emitting plates once a years, don't you think there would be something better by now? Damn right! I say fewer mammograms, but no restrictions on Ultrasounds or Thermography. I also say that the fed needs to keep its nose out of our sex lives. Therefore, no ultimatums, if you please, about what women do about their own pregnancies. If the government can tell us we can't have abortions, it can also tell us we can't have children. Anti-abortionists don't realize that they're supporting an action that establishes a precedent for government interference in women's childbearing options either way.

9:39PM PST on Nov 21, 2009

I have found every single breast lump myself. I demand they do an ultrasound every time I find a lump and they (the radiology facility) refuses to honor my request and insists on doing a mammogram FIRST, then an ultrasound. Not once has the mammogram detected any abnormalities, yet I continue to be subjected to radiation, but the ultrasounds have found abnormalities every time. I'm 46, have never had children, so I have very dense breast tissue making mammography both worthless but also extremely painful.

So here's my point: each of us is unique. Annual mammograms help some, while do nothing but harm others. If you fall in the category where a mammogram is effective for you, your doctor can prescribe one for you and your insurance really should pay if this is something your doctor thinks you need. HOPEFULLY health care reform will help to solve some of these issues.

Ditto for pap smears, some women will need them more frequently than others. It's ridiculous for everyone to have them annually.

Consider the opposite arguement for a moment. With the insurance companies being as greedy as they are, let's say Mammograms are recommended 1x/year. What is to stop an insurance company to REFUSE treatment for patients who forgo mammograms due to their failure to deduct anything and only expose you to radiation?

One last thing, mammograms alone can exacerbate an existing tumor by rupturing it and causing it to spread. Do you still want your breast traumatized knowing this

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