More on mammography for women under 50

11/19 KHN has a round up of the reaction to the news guidelines.

Now comes another reversal in the mammography debate. (See ACS flap.) On Monday, a U.S. government agency backed away from a more aggressive approach and concluded that, in the balance,  women in their 40s get no net benefit from mammography. The U.S. Preventative Services Task Force (USPSTF), which studies the effectiveness of screening programs, concluded that even women in their 50s don’t need them annually.

Ann Grady Ready: Full mastectomy in the '80s. Died from allergies later.

The USPSTF found fair evidence that women who have screening mammography die of breast cancer less frequently than women who do not have it, but the benefits minus harms are small for women aged 40 to 49 years. Benefits increase as women age and their risk for breast cancer increases. However, there are relatively few studies of mammography for women aged 75 years or older. The potential harms of mammography include anxiety, procedures, and costs due to false-positive results and receiving a diagnosis and treatment of cancer that never would have surfaced on its own within a woman’s natural life time. They found that the benefit of mammography every 2 years is nearly the same as that of doing it every year, but the harms are likely to be half as common. They found no evidence that self- or clinical examination reduces breast cancer death rates.

Some Boston doctors reject this idea in the Globe story:

The new guidelines, published in the Annals of Internal Medicine, stoked unusually harsh responses for the clubby world of academic medicine. Some prominent specialists branded the recommendations as flat-out wrong, with one Boston radiologist, Dr. Daniel B. Kopans of Massachusetts General Hospital Cancer Center, predicting the guidelines “will condemn women ages 40-49 to unnecessary deaths from breast cancer.’’

And while many mainstream breast cancer advocacy groups will agree, others don’t.   The National Women’s Health Network — a Washington D.C.-based group that grew out of the feminist health movement of the 1970s — says their members “don’t want overly optimistic information or simplistic messages that are better at motivating than educating.” The network, like other women’s health advocates, pushed for access to the mammography in the ’70 and ’80s, but eventually began to question the test. 

            So, they offer their members a collection of recommendations from like-minded activists and researchers. One comes from Dr. Susan Love, who has made a career out of offering advice on breast cancer: “Even in older women, mammography is far from a perfect screening tool. It may help you find your cancer early, but finding a cancer “early” is not a guarantee that your life will be saved.” The evidence-scrutinizing Center for Medical Consumers says “Mammography-detected breast cancers have the best outlook. The screening test also leads to the detection and treatment of breast cancers that would never become life-threatening. Mammography’s role in the nation’s declining breast cancer death rate remains unclear.”  Breast Cancer Action — a feisty Bay-area group that prefers boycotts to pink ribbons — says: “The quality of mammography screening varies widely. Mammography is an imperfect test. The benefit of routine mammograms for healthy pre-menopausal women is unproven.”

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