New guidelines released by the U.S. Preventive Services Task Force advise that women ages 40 to 50 shouldn't bother with mammograms. Also, don't worry about giving yourself a self-exam - the panel claims they just don't work.
The new guidelines weighed the risk of false-positive tests against the benefits of screening women for breast cancer and found that although some lives were saved, more hospitals were ordering needless tests, and more women were being subjected to anxiety and stress, than was truly necessary. While for many, a false positive seems like no big deal - worth it, when you consider the alternative - the government-funded panel says the risks of a false positive are real, and can result in unnecessary treatment for cancers that are growing too slowly to be an issue during a woman's lifetime. False positives and the battery of unnecessary testing that follows may cause extreme panic and anxiety, which can also adversely affect the body.
To arrive at their radical new guidelines, the task force examined several studies from England and Sweden. They also commissioned six groups to make make statistical models to analyze date. These groups were essentially brought in to answer the question: How much does it benefit women over 40 to get screened for breast cancer every year, and do these benefits outweigh the (often quite high) cost? Donald A. Berry, a statistician at the University of Texas and a leader of one of the modeling groups, says that they almost unanimously found that there was "very little" benefit to screening women, "so little as to make the harms of additional screening come screaming to the top."
For younger women, they found that the benefits of screening for cancer are low when weighed against the risks of a false positive. For each case of cancer-related death prevented among women under 50, 1,900 women must be screened, according to their report. For women 50-59, the ratio drops to 1 for 1,300, and for women aged 60 to 69, 1 for 377.
The task force still advises that women with the breast cancer gene get routinely screened, but suggest that women at a normal risk should forgo yearly testing until their 50s. They were even more blunt about the benefits of performing self-examinations. "Women should know it doesn't work," said Dr. Diana Petitti, vice-chairman of the task force. And naturally, there are studies to back this up: Two large studies involving 200,000 women in China and over 100,000 in Russia found no benefits from breast self-examinations.
While the National Cancer Institute has announced plans to re-evaluate their guidelines in light of the report, the American Cancer Society and the American College of Radiology both said they are sticking to their current guidelines, which advise annual mammograms for women over 40. Phil Evans, a professor of radiology from the University of Texas Southwestern Medical Center and president for the society for Breast Imaging, says he is "shocked" by the new findings. "There's a ton of scientific data in this country and others on screening that shows a significant benefit for women between 40 and 49 to be screened," he says. He also points out that the task force's interpretation of data did not take into account the fact that saving younger women leads to more "life years saved" than for older women. Dr. Constance Lehman, chair of the American College of Radiology, says that mammograms are necessary for early detection, and can "put them in a group of women where they more likely can have their breasts conserved. Without that early detection they are much more likely to be told they need the breast removed." She says younger women and African-American women are increasingly developing aggressive cancers that will not be detected if they are only screened every other year.
Of course, one of the biggest issues to come out of the new guidelines relates to how they will effect health insurance. The Centers for Medicare and Medicaid Services will continue to cover annual mammograms (congress currently requires Medicare to cover yearly screening for patients), but many private companies may feel differently. The guidelines will also change the grading system for health plans, which are issued by the National Committee for Quality Assurance, and are used as a marketing tool. One measure of the grading is based upon the percentage of patients getting mammograms every year starting at age 40.
While some researchers fear that the new report will be viewed as a political effort by the Obama administration to save money on health care costs, Dr. Berry is quick to note that the money is only one consideration. "The money was buying something of net negative value," he said. "This decision is a no-brainer. The economy benefits, but women are the major beneficiaries."
Less-Rigorous Guidelines For Breast-Cancer Screenings [Wall Street Journal]
In Reversal, Panel Urges Mammograms At 50, Not 40 [New York Times]
Panel: Mammograms Should Start At 50, Not 40 [NPR]