New Mammogram Recommendations - They're Just Recommendations

Now that the media and the U.S. Preventive Services Task Force have backed off from the Task Force's recent recommendations¹ to reduce mammogram screenings for women between the ages of 40 - 49 who are not at risk for breast cancer, it's time for reason to weigh in.

Upon first hearing the sound bite that "women should no longer get annual mammograms" I was initially elated for myself, but admittedly confused. Amid the nonsensical rhetoric about rationing health care and the emotional outrage² from women who claim they would now be dead had their breast cancer not been found during a routine mammogram or self-exam when they were 40-49, I sensed something was missing from that sound bite.

An initial emotional response to the sound bite is understandable and valid. All voices have the right to be heard (including those of the physicians on the Task Force). But emotions born of misunderstanding are not helpful to the cause, which is of course saving lives, and there has been a myriad of misinformation and misunderstanding about the new report feeding the outraged emotional responses, many of which come from breast cancer patients and those at risk whose care recommendations have not changed.

First, the U.S. Preventive Services Task Force is not the only body making mammography recommendations³ - and it would certainly take more than one body's "recommendations" to change any laws. The recommendations are not related to health care reform and in fact include the following disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Lost in the misinformation - and poor reporting - of the recommendations was the Task Force's intent to personalize the decision of mammography, not to deliver a "cost-cutting smokescreen that could limit choices and risk lives". Individualizing the risk, screening and care of breast cancer in women could lead to much better prevention and ultimately save more lives. Currently, even high-risk patients rarely receive chemoprevention, which practice would be subject to change (ultimately saving more lives) if more personalized breast cancer risk and care measures adopted.⁴

Opponents of the Task Force recommendations may not realize that repeated exposure to radiation can put a patient at greater risk for cancer. Being a woman in her 40's who has already suffered a great deal of radiation exposure and who has survived cancer, but is still at great risk of occurrence/recurrence for cancers other than breast cancer, I am not well served by the currently mandated annual mammograms. In a comment made to the Public Insight Network, Jennifer Clark made a similar observation: "In the 1990s. a physician wrote an article in Atlantic Monthly in which he was highly critical of routine mammogram practices. Although not a physician, I am a scientist. His viewpoint was compelling to me. When I began taking HRT, however, a yearly mammogram was a price I was forced to pay in return for HRT prescriptions. The new guidelines liberate me by allowing me to do what I have wanted to do for years--treat routine mammograms as a "less is more" procedure."⁵

And Te Pazdral of Massachusetts wrote: "I am a physician. I have spent last few years discussing with friends the lack of data showing the benefit in women 40 to 50 with no family history, and ample evidence of harm in increased procedures."⁵

Dr. Susan Love (aka "The Breast Doctor") writes: "...there are several studies calculating the risk from the cumulative radiation of annual mammograms starting at 40."⁶

Additionally, the ~3% decrease in breast cancer deaths cited by the American Medical Association is due to a combination of earlier detection and better therapy, not mammography alone. Suggesting otherwise may give rise to complacency on the part of researchers to expedite the search for a cure.

Opponents of the Task Force recommendations should consider the likelihood that a false reliance on mammography is prohibiting or postponing research that would uncover newer, better, safer, more reliable ways of detecting breast cancer. Dr. Love says: "I actually believe that we need something better for younger women and wish we could refocus the discussion from arguing about a less than perfect tool to finding the cause of this disease."⁶

Rather than arguing over sound bites and untruths, it might be wise to accept the report for what it is as well as what it isn't. What it is -- one study among many, an attempt to bring about the personalization of breast cancer detection and treatment, and information that can help everyone make better decisions. It is not - a law, mandate or anything else that would give insurance companies a[nother] loophole to avoid covering mammograms. It is not part of health care reform. It does not "ration" health care.

Those who remain afraid of the new recommendations (and everyone else, for that matter) continue to be well served by common sense: if you need a mammogram or feel any lumps anywhere in your body, see your doctor - period.

_______________________________________________________________

¹Screening for Breast Cancer Recommendations, United States Preventive Services Task Force, 2009

^{2­­­­­­­­­­­­­­­­­­­­} ­­­­­­­­­­­­­­­­­­­­ Despite being low risk, I had a base mammogram at age 35 and yearly mammograms starting at age 40 as recommended by my doctor. This year my mammogram results appeared irregular and I went in for more tests. The end result was that at age 43 I was diagnosed with breast cancer. I underwent a mastectomy a short time later. Where would I be at age 50 without having had a mammogram? Quite likely six feet under. Is it not worth others to undergo a bit of discomfort and/or the possibility of a false positive so that lives like my own can be saved? -Jennifer Hartman, Los Angeles, CA

³In 2002, the American Medical Association began recommending annual mammograms for women beginning at age 40. It wasn't until 2003 that the American Cancer Society made this recommendation and in 2009, the National Comprehensive Cancer Network made a similar recommendation. However, in 2003, the American College of Obstetrics and Gynecology recommended mammography only every 1 to 2 years beginning at the age of 40 and in 2009, the World Health Organization recommended mammography only every 1 to 2 years from the age of 50. (USPSTF, 2009)

⁴Miscommunicating the Mammography Message. Atlantic Monthly

⁵Public Insight Network

⁶Dr. Susan Love