In November 2009, the U.S. Preventive Services Task Force (USPSTF)
published new guidelines for breast cancer screening by mammograms
which sparked controversy on a vital topic to cancer organizations
worldwide, the importance of early cancer detection. These new
guidelines are a significant shift from those issued in 2002, which at
that time, recommended women ages 40 and older to have an annual
mammogram. The new recommended ages by the USPSTF to screen women
for breast cancer is now 50 and older, leading to many questions on
why such a change in policy is necessary.
Immediately after this recommendation from the USPSTF, a statement
from Otis W. Brawley, M.D., chief medical official of The American
Cancer Society, stated, “The American Cancer Society continues to
recommend annual screening using mammography and clinical breast
examination for all women beginning at age 40….reasonable experts can
look at the same data and reach different conclusions….the Society’s
panel found convincing evidence that screening with mammography
reduces breast cancer mortality in women ages 40-74…. With its new
recommendations, the USPSTF is essentially telling women that
mammography at age 40 to 49 saves lives; just not enough of them… The
most recent data show us that approximately 17 percent of breast
cancer deaths occurred in women who were diagnosed in their 40s.”
According to the American Cancer Society’s cancer statistics, this 17%
represents approximately 7,000 lives, which will be left at risk once
these breast cancer screening policy changes take effect.
Additional support for breast cancer screening comes from researchers
at the University of London, which conducted two studies looking into
the risks and benefits of breast cancer screening. The first study
predicted the number of women who would have died from breast cancer
in Britain without screening. The second study evaluated the number
of deaths among 80,000 Swedish women with access to screening
programs. The results published in the Journal of Medical Screening
showed that for every 28 breast cancer diagnoses between 2 and 2.5
lives were saved. The results from the Swedish study indicated that
for every 350 women screened for 10 years for breast cancer, one life
would be saved. This research, along with hundreds of other
publications, indicates an opportunity for saving lives from further
development and implementation of cancer screening.
As stated on the Agency for Healthcare Research and Quality’s website
(www.ahrq.gov), the USPSTF mission is “to improve the safety, quality,
efficiency, and effectiveness of health care for all Americans.” The
recommendations of the USPSTF are considered to be the “gold standard”
for clinical preventive services, and are followed by almost every
major primary care and federal agency associated with health care.
USPSTF recommendations are used in undergraduate and post-graduate
medical and nursing education as a key reference for teaching
preventive care.
So what is the reasoning behind the USPSTF’s breast cancer screening
recommendation? False positives can lead to psychological distress,
unnecessary imaging tests and biopsies in women without cancer, and
inconvenience due to false-positive screening results. Radiation
exposure, although a minor concern from mammograms, is also a
consideration. The USPSTF recommends that physicians be required to
consider additional factors, such as an individual’s personal risk of
having cancer, before conducting screening procedures such as
mammograms.
It is up to the individual and his/her doctor to determine if
screening tests will be implemented. If the health care provider does
not cover screening tests which are preferred by the patient, other
options are available from the private sector to address these needs
at the patient’s own cost.
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References:
1. Agency for Healthcare Research and Quality, Rockville, MD
2. American Cancer Society (ACS) American Cancer Society Responds to
Changes to USPSTF Mammography Guidelines.
http://www.cancer.org/docroot/MED/co...Guidelines.asp
3. American Cancer Society (ACS) Cancer Statistics 2009.
http://www.cancer.org/docroot/PRO/co...esentation.asp
4. Duffy, S., McCann, J., Godward, S., Gabe, R., Warwick, J. “Some
issues in screening for breast and other cancers.” Journal of Medical
Screening. 2006; 13(Suppl1): S28-S34
5. U.S. Preventive Services Task Force. Screening for breast cancer:
U.S. Preventive Services Task Force recommendation statement. Ann
Intern Med. 2009;151:716-26, W-236. [PMID: 19920272]