The new mammography screening guidelines: A medical decision or a political decision?

By Ellen Shaw de Paredes, MD
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Dr. Shaw de Paredes is a Radiologist and Owner of the Ellen Shaw de Paredes Institute for Women’s Imaging in Glen Allen, VA. She is a member of the editorial board of this journal.

On November 16, 2009, the U.S. Preventive Services Task Force, a federally funded group, issued a report after analyzing some old data and concluded that screening mammography is not recommended for women under 50, and should be performed only every other year from 50 to 74. This unfortunate conclusion landed mammography on the front page of many newspapers.

Breast cancer is a politically charged disease. Years ago, a diagnosis of breast cancer was kept secret. Now through the efforts of many professional organizations, the stigma of breast cancer no longer exists. Awareness has been raised to a level not seen with any other disease. Think about it — in efforts to raise awareness during the month of October, now dubbed Breast Cancer Awareness Month, airplanes have been painted pink, men’s professional athletic teams wear pink socks and jerseys, and pink ribbons have become ubiquitous. Of all diseases, the U.S. Preventive Services Task Force took on breast cancer and mammography screening! The value of human life was questioned by this group and apparently has been reduced considerably by them.

The decision to recommend against the current guidelines was a very poor one. Extensive randomized controlled trials have shown a 30% to 45% mortality reduction from breast cancer in screening mammography groups vs. control groups. With the onset of mammography screening in the United States, the death rate from advanced breast cancer has dropped by 30% since 1990, even though it was unchanged for the 50 years that preceded. The Task Force acknowledged that more women will die of breast cancer if screening mammography is not performed under age 50 and not performed annually after age 50. Radiologists, breast imagers, breast surgeons and oncologists are speaking out about the conclusions of the Task Force that, if incorporated, will turn the tide from saving more lives from breast cancer to losing more lives from this terrible disease.

More importantly, women are outraged. The public is speaking out about this decision. Young women who were diagnosed with breast cancer through mammography screening are among those whose lives could have been changed forever had these Task Force recommendations been implemented. However, not all are aware of the important facts — that there was no new study, that the guidelines of the American Cancer Society and our other professional organizations have not changed. Unfortunately, those women who may have been hesitant about mammography will be more so, and they may not undergo this potentially life-saving test.

Recently, I published an editorial in a Richmond, VA, newspaper about this topic. The next day as I went through the check-out at the grocery store, the clerk said that he had really enjoyed the article and hoped that more people would speak up. We must educate our patients and referring physicians about what we know from the science: that screening mammography performed annually in women 40 and older reduces breast cancer deaths by at least 30%. We must let our legislators hear our voices and opinions, especially now as health care reform is debated. We must be empowered to speak up about this decision that certainly cannot be a sound medical one, but instead seems to be based on politics and economics.

If these recommendations are implemented, my 40-year-old patient with 3 young children and early stage breast cancer would probably not have survived her disease if she waited until the findings were clinically apparent or until age 50. What does her life mean? —obviously much more to her family, her children—than it does to the Task Force who identifies her only as a statistic. The Task Force cited anxiety about a recall from screening as being one of the reasons to not screen at the currently recommended age and frequency.As we physicians who take care of patients know, the anxiety and pain associated with a diagnosis of advanced breast cancer is far greater than that associated with a screening recall that results in a benign diagnosis.

Much scientific study and effort has been placed upon determining the role, value and frequency of screening mammography. The mortality reduction for breast cancer is significant when women undergo screening mammography annually after age 40. Please educate your patients and referring physicians about what we know is correct and encourage them to continue to follow our well-established guidelines for screening mammography. Many women are alive and well today because they followed the current guidelines.

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The new mammography screening guidelines: A medical decision or a political decision?.  Appl Radiol. 

March 04, 2010

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