On April 30, new guidelines were released from the United States Preventive Services Task Force, saying that women should begin regular breast cancer screening at age 50, instead of the previous age 40 recommendation. This group gives guidance to doctors, policy makers and insurance companies.
There is a small group of women who have unusual risk factors for breast cancer who should ignore the new guidelines and get yearly mammograms beginning at the age their doctor recommends.
The new guidelines override the long-established recommendations and their goal is to decrease damage from over treatment. It also suggest that women age 50 to 74 should get mammograms every two years, instead of the previously recommendation of every year. Plus it even said that doctors need to discontinue telling women to examine their breasts on a regular basis.
It was just seven years ago that the same group, containing different members, recommended that women get mammograms every one to two years beginning at age 40. Not enough verification was found to take a firm stand on breast self-examination.
The federal Department of Health and Human Services is the group that appoints the independent panel of experts that make up the task force.
The new guidelines, which will probably cause plenty of controversy over the benefits of breast cancer screening, are published online in The Annals of Internal Medicine.
A screening test can be harmful according to medical experts who say the risks are real. A test can spark more tests, such as biopsies, that can create overwhelming anxiety. I myself have experienced this firsthand. In my mid-40s I had a routine mammogram in which some small calcium deposits were detected. From there I went through a biopsy, along with extensive radiation from what I felt like was a ridiculous amount of x-ray pictures taken of various angles of my left breast. After all that, I had to wait an excruciating 14 days of anxiety to find out that everything was O.K.
The report says that the limited benefit of mammograms, reducing the breast cancer rate by 15 percent, needs to be measured against the harms. Those harms are more immense for women in their 40s, because they are 60 percent more likely to experience them than women 50 and older, but less likely to develop breast cancer, distorting the risk-benefit equation. The task force surmised that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, in contrast with one death for every 1,339 women age 50 to 59, and one death for every 377 women age 60 to 69.
Of course the guidelines do not apply to women who are at increased risk for breast cancer due to a gene mutation making cancer more likely or because they have had substantial amounts of chest radiation. Experts also said that women with close relatives who have had breast cancer were also at higher risk.
The National Cancer Institute said that it was re-evaluating its previous guidelines because of the task force’s new report. This said, the American Cancer Society and the American College of Radiology both said that they are standing by their guidelines that advise women to begin annual mammograms at age 40.
Dr. Diana Petitti, vice chairwoman of the task force and a professor of biomedical informatics at Arizona State University, said she knew the guidelines would be shocking for many women, but “we have to say what we see based on the science and the data.”
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