CDC Publishes New Mammography Study, Recommendations

The controversy started before the ink was dry in the newspapers and even before the web sites could be updated.

In a report published in the November 17, 2009 edition of the Annals of InternalMedicine, the Centers for Disease Control and Prevention's (CDC) Preventive Services Task Force has challenged the prevailing conventional wisdom, as well as its own published guidelines, regarding the effectiveness of routine (screening) mammography for the early detection of breast cancer in women 50 years of age and under.

The published report states that, based on the low actual incidence of breast cancer in women under 50 (< 3% of all proven breast cancers), and the ratio of the number of normal exams to the number of exams in which a suspicious area is detected, mammography is not cost-effective as a screening tool

The recommendations were made after a detailed study of mathematical models, which were based on previously-published data examining the incidence of breast cancer in all age groups as well as the past results of mammography when used as a routine screening examination in the same groups.

In response to the Task Force's suggestions, the American Cancer Society (ACS) vigorously restated its longstanding recommendation that routine screening mammography begin at age 40 or possibly earlier, if medically indicated by a woman's medical history.

Comment

At any other time the above-cited report and recommendation would be just another matter for debate within the professional medical community and, in all probability, would have been reported on somewhere toward the back of the front section of the local newspaper. But these are not normal times, simply by reason of the ongoing ruckus over health care "reform" and, with it, the well-established doctrine that government bureaucrats are hopelessly incompetent when it comes to understanding statistical data.

My greatest concern is that the CDC data will be taken out of its clinical context and used to justify a broad denial of payment for mammography services in what will eventually become national health care policy. If payment for mammography services is sharply curtailed will this, by extension, eventually reduce coverage for other screening and detection modalities such as colonoscopy, Pap smears, and Prostate Specific Antigen (PSA)? In the latter case, the CDC's Task Force has already challenged its usefulness in a similarly-constructed study.

As mentioned above, the CDC Task Force considered only data from the female population at large (all ages and socioeconomic groups) and notexclusively in a population with known risk factors such as a family history of breast or some other type of cancer or in women of any age with a known abnormality of the BRCA1 / BRCA2 genetic markers. It is almost certain that mammography will be of greater utility in the surveillance and early detection of cancer in this subgroup.

For those of you with an interest in women's health issues, you might a well pull up a chair and get comfortable because this one isn't going to be settled for a few years.

Note

1. US Preventive Services Task Force: Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med November 17, 2009 151:716-726 (Abstract).