Mammography Recommendations Spur Debate
Recent news that a federal government panel has proposed major changes in screening recommendations for breast cancer has spurred much discussion among those in the cancer community.
The U.S Preventive Services Task Force (USPSTF), in a report published in the Annals of Internal Medicine, now recommends that routine mammography screening for women at average risk should begin at age
50, challenging guidelines that women have followed for years-that is, starting yearly mammograms at 40. In addition, the new recommendations advise women to have their mammogram every other year rather than once a year, and end routine screening after age 74. In addition, the task force recommends against teaching breast self-exam.
“I’m afraid all the women in their 40s won’t get the same opportunity I had,” says Fox Chase Cancer Center nurse and breast cancer survivor Deena Dell, M.S.N, R.N.-B.C., A.O.C.N., who was diagnosed with breast cancer at age 45 after having a mammogram. If I had waited till I was 50 to be screened, my breast cancer might have been invasive, which would have required more aggressive treatment.”
“This could have a huge impact, especially because women in the younger age group tend to have cancers that are more biologically active and more aggressive,” notes Kathryn Evers, M.D., director of
mammography at Fox Chase.
“The fear is that we may start to see an increase in the number of advanced cancers as well as an increase in deaths from breast cancer,” adds Kenneth Blankstein, MD, Medical Oncologist at Hunterdon
Regional Cancer Center.
In making the new recommendations, the USPSTF cited evidence that mammograms among women ages 40-49 bring about more risks than benefits with false-positive results, leading to undue anxiety in patients as well as unnecessary follow-up tests and procedures.
While some in the cancer community support the proposed recommendations, there are many cancer experts who disagree with them. Mary Daly, M.D., Ph.D., chair of Fox Chase’s clinical genetics department, says the task force’s reevaluation of existing studies was flawed by its reliance on data from older technology, namely film mammography. Digital mammograms, which have become the current standard
for breast cancer screening, are more sensitive than film screen mammograms in women under 50.
“I’m going to tell my patients to continue getting screened as they have been,” she says. Blankstein agrees, saying he will continue to recommend annual mammograms to his patients. In addition, the
American Cancer Society continues to advise that all healthy women begin yearly mammography at age 40.
With the new recommendations, many also have concerns that Medicare and private insurers may stop paying for yearly mammography, although insurance industry groups claim this is not planned. If women were to be required to pay out of pocket for breast cancer screening, that would be a step backward, says Daly.
In contrast, when it comes to breast self-exam, the trend in recent years has been more in line with the new recommendations. Patient advocacy groups have placed greater emphasis on the idea of breast
awareness-that is, telling women to know their bodies and recognize changes that are not normal for them. Still, experts such as Lori Goldstein, M.D., director of Fox Chase’s Breast Evaluation Center,
note that doing a breast self-exam is “value-added and complementary to mammography screening.”
“There’s been a lot of discussion over the years about mammography,” notes Blankstein. “But I think what we need to keep in mind is that mammography is the only test we have right now that has been demonstrated to decrease mortality from breast cancer.”
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