The U.S. Preventive Services Task Force issued new guidelines on breast cancer screening today that do away with the â€œevery woman should have an annual mammogram starting at age 40â€ recommendation women have long heard from their doctors.
The new recommendations are:
â€¢ Screening mammography should not be done routinely for all women age 40 to 49 years.
â€¢ Women and their doctors should base the decision to start mammography before age 50 on a womanâ€™s individual breast cancer risk and her understanding of the benefits and harms.
â€¢ Women age 50 to 74 years should have mammography every 2 years.
â€¢ More evidence is needed for the USPSTF to recommend for or against screening mammography after age 74 years.
The new recommendations also note that:
â€¢ The USPSTF recommends against teaching patients breast self-examination.
â€¢ Available studies do not provide enough information to know whether breast examination by a trained medical professional adds beneï¬t beyond mammography.
â€¢ There is not enough information to know whether newer types of mammography (digital mammography) or magnetic resonance imaging are any better than regular ï¬lm mammography results.
The USPSTF is a group of health care experts that reviews published research and makes recommendations about preventive health care, and itâ€™s recommendations are considered the “gold standard” for clinical preventive services. This means that these recommendations are likely to be widely adopted and have the potential to broaden all womenâ€™s understanding of the benefits and harms of mammography as well as help them understand what we truly knowâ€”and how much we still need to learn–about breast cancer prevention and early detection.
Many doctors now advocate that women begin mammograms at age 40. But the fact is the decision to change the age at which mammography screening begins in this country from age 50 to age 40 was always controversial and was never unanimously supported. Thatâ€™s because mammography is not as good a tool in younger women.
The studies also are pretty clear that whether you have a mammogram every year or every two years after 50 the results are about the same. In fact, most European countries do mammography every two years, with similar results to those in the U.S.
Furthermore, the use of breast self-exam to â€œfind cancers at a curable stageâ€ has never been supported by randomized controlled data.
Recommendations on mammography screening must also take into account our new understanding of the biology of breast cancer. We used to think that all cancers were the same, that they all grew at the same pace, and that there was a window when all breast cancers could be caught before they spread. We now know that there are at least five different kinds of breast cancer based on their molecular biology. Some breast tumors are so slow growing and are so unlikely to spread that they will never do any harm. Others grow and spread very quickly. The idea that they all can be â€œcaught earlyâ€ is wishful thinking. In fact screening is best at finding the â€œgood onesâ€ that might even disappear if left alone. Remember the reduced the mortality from mammography is 30% not 100%! If early detection always worked, the number of aggressive cancers we see would have gone down as a result of screening. But as a recent article published in the Journal of the American Medical Association made clear, thatâ€™s not what has happened.
The goal of breast cancer screening should be this: to find the cancers that have the potential to kill you, so that an intervention is necessary and can make a difference. We need to stop finding the cancers that will never do anything, and stop over-treating women who have them.
For this to occur, we need to do help women understand what mammography can and cannot do, and focus on finding the cause of breast cancer and preventing it altogether. I donâ€™t want women going for mammograms they donâ€™t need, or feeling I false sense of security because they have had one. I want them to have the opportunity to take part in the research that we need to go beyond a cure! Thatâ€™s the reason we started the Love/Avon Army of Women. [armyofwomen.org]. And thatâ€™s why I need you and everyone you know to sign up today!