We felt that this needed to be posted again!

You may have heard that the U.S. Preventive Services Task Force (USPSTF) issued new recommendations for breast cancer screening this week, which include many changes from prior recommendations. There has been an outpouring of responses and media attention since the announcement was made. The American College of Radiology released a statement saying that these changed recommendations will result in “countless unnecessary breast cancer deaths each year.” The American Cancer Society as well as the American College of Obstetrics and Gynecology also disagree with the recommendations, and believe that women should continue to follow the prior recommendations. In fact, the Secretary of Health and Human Services issued a statement telling women to keep getting mammograms as they’ve been doing in spite of the USPSTF recommendations.

What are these new recommendations that have created such confusion among patients and controversy among physicians? The two major changes include:

· not routinely screening (with mammograms) women ages 40-49, biennially screening women ages 50-74, and screening ages 75 and beyond based on general health;

· discouraging teaching breast self-exams

What is the controversy? Previously, it was recommended that all women begin getting routine mammograms at age 40, and yearly thereafter. No age group has been considered too old to get mammograms. In addition, the teaching of breast self exam (BSE) has been for years a major part of the campaign for early detection of breast cancer.

This is confusing, but here’s what you need to know.

The recommendations were based on two reports, commissioned for this Task Force, that combined and synthesized research data from the past seven years, which was when the USPSTF made its last recommendations. Several important results, which affected their recommendations. were found in these reports:

1) the largest number of mammograms that were false positive (ie, showed an abnormality that was not cancer when biopsied) occurred in women ages 40-49 – thus, mammograms in this age group led to many unnecessary biopsies;

2) mammograms done every year do not significantly reduce the death rate from breast cancer, whereas mammograms done every two years do reduce the death rate significantly – this says that mammograms done every two years minimizes the risks while maximizing the benefits of mammography in the largest number of women;

3)teaching breast self-exam does not reduce the number of deaths from breast cancer, and can cause harm in that more unnecessary imaging and biopsies done in women who find abnormalities by BSE;

4) there was not enough information about the number of deaths from breast cancer in women ages 75 and older because the data showed that more deaths are due to heart disease and strokes in this group – therefore no recommendations could be made about mammograms for women of this age.

You can probably see from the above findings that the USPSTF based its recommendations on large groups of women in the general population, and not those with risk factors for breast cancer. In addition, their recommendations were made based on death rates caused by breast cancer; in studies that looked to see if mammograms affect the chance of living longer in a significant number of women, the answer was yes – early detection of breast cancer improves survival and saves lives. It almost seems that the recommendations were also based on what was cost-effective for the general population.

The most important point I want to make here is the same one we make in our book. Each woman has a unique medical history and lifestyle; because of this, decisions on your healthcare should be made based on your individual genetic make-up, medical history and lifestyle, not on generic recommendations made to all women. If you’re concerned about the frequency of your routine mammograms, talk to your clinician about the best screening schedule for you, especially if you have a family history of breast cancer. If you don’t know your risk for breast cancer, ask your clinician to discuss this with you. If you’re comfortable with BSE and wish to continue, then go ahead and do so. And DEFINITELY, if you find a lump in your breast, don’t ignore it. See your clinician immediately about it.

The worst thing would be to become so confused or upset by these recommendations that you don’t do any preventive health maintenance. Remember, these are only recommendations and could (and probably will) change again at any time. Even the experts don’t agree on them. You should do what’s best for you and your health.