To Follow the New Mammogram Recommendations or Not to Follow Them?

The new Mammogram recommendations, which came from a United States Preventive Services Task Force (USPSTF) that originated in the 1980's (and was not created by the Obama administration,) counsels women who are not at high risk for cancer to begin having screening mammograms performed every other year (biennial) at age 50, rather than the previous recommendation of starting routine mammograms at age 40. The task force also said that women between the ages 50 to 74 should get a mammogram every other year until they turn 75, the reason being that after the age of 75 the risks and benefits are unknown. Finally they advised against teaching breast self-examination because the study deemed there to be moderate or high certainty that the service has no net benefit. According to the Susan G. Kormen website: "there has never been clear evidence that breast self-exams reduce breast cancer mortality".

The USPSTF's Clinical Summary of these guidelines indicated that the evidence showed a biennial screening schedule maintained most of the benefits of annual screening mammograms and cut the harms nearly in half.

What are some of the "harms" they are referring to? research has shown that the potential hazards of cumulative ionizing radiation from routine mammogram exposure can actually cause cancer, especially in premenopausal women, typically under the age of 50. In 1995 the British medical journal , The Lancet, reported that: "Since mammographic screening was introduced in 1983, the incidence of ductal carcinoma in situ (DCIS), which represents 12% of all breast cancer cases, has increased by 328%, and 200% of this increase is due to the use of mammography." And according to the Center for Medical Consumers, in 2005, " For every 1,000 women who undergo mammography screening for ten years one woman will have her life prolonged; five additional women will receive an unnecessary cancer diagnosis and treatment ( over-diagnosis ) and three women will have a benign tumor biopsied."

The new guidelines do stress that the "biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms." and "the small chance of detecting breast cancer on a screening mammogram in women younger than 50 years is outweighed by the psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results."

One of the concerns regarding these new recommendation is if insurance companies will stop paying for screening mammograms for women under the age of 50. There is no way to know at this time, but Health and Human Services Secretary Kathleen Sebelius told CBS News, "No coverage changes will be coming, Medicare will continue to pay for mammograms. Medicaid will continue to pay for mammograms, and frankly, I'd be stunned if private insurers change any coverage decisions." Susan Pisano, vice president of communications for America's Health Insurance Plans (AHIP) said the she does not believe Insurance will vary their coverage based on whether a woman who gets a screening mammogram is in the target age group or not.

The new recommendations are actually more consistent with international guidelines, which call for screening to start at age 50; the World Health Organization (WHO) recommends the test every two years, and Britain counsels women to start at age 50 and then re-check every three years.

So who do we believe and what is in our best interests as women ? It looks to me like the risks of having screening mammograms at any age are higher than the benefits. Personally I am going to think long and hard about having any more mammograms and I am seriously thinking about foregoing screening mammograms altogether. Apparently there are safer tests that can be performed. I intend to find a physician well versed in this area and ask plenty of question before having any more screening mammograms regardless of my age.

Bottom line is that following or not following the new recommendations is a choice women need to make based on their own perceptions of the risks versus the benefits, their beliefs about preventative services for breast malignancies, as well as family history, personal health issues, personal values and any other factor that applies for them. All in all this is is a personal decision and the new guidelines are recommendations not requirements.

U.S. Preventive Services Task Force
http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm
JOCELYN NOVECK
http://bulletin.aarp.org/yourhealth/diseases/articles/new_mammogram_advice_raises_questions_concerns.html?CMP=KNC-360I-GOOGLE-BULL&HBX_OU=50&HBX_PK=mammogram_recommendations
AARP bulletin today
Kerri Wachter, @knwachter on Twitter
http://egmnblog.wordpress.com/2009/11/17/new-mammogram-recommendations-miss-the-real-fear/
EGMN notes from the road
http://ww5.komen.org/ExternalNewsArticle.aspx?newsID=44299
Susan G. Komen for the Cure
Annals of Internal Medicine
The Associated Press
http://www.nhne.org/news/NewsArticlesArchive/tabid/400/articleType/ArticleView/articleId/6313/language/en-US/Stop-Annual-Mammograms-Govt-Panel-Tells-Women-Under-50.aspx
www.medicalconsumers.org.
Mammography debate puzzles many
http://www.cbsnews.com/stories/2009/11/19/earlyshow/health/main5710326.shtml
Chris Gupta
http://www.communicationagents.com/chris/2003/06/10/the_depths_of_deceit_mammography.htm
The depths of deceit mammography