US Preventive Services Task Force Releases New Guidelines for Mammograms

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The US Preventive Services Take Force releases new guidelines reiterating women should get mammograms starting at age 50, not 40, even after debate 6 years ago

The guidelines focus on studies that underestimated the lifesaving benefit of regular screening and focus on over diagnosis claims.

It seems the task force has ignored more modern studies that have shown much greater benefit. These limitations result in the misrepresentation of real trade-offs that women and health care providers need to know about for making informed decisions when it comes to screening.

Breast Cancer Screening and Prevention

The guidelines:

  1. Women ages 50-74 get mammogram every 3 years
  2. Women ages 40-49 make own decision on whether to screen in consultation with their doctor

The task force concluded that there isn't enough evidence for or against mammograms for women 75 and older. They also concluded not enough evidence existed for a newer technology, 3-D mammography, additional screening for women who have dense breasts.

Thankfully the guidelines highlight family history as a consideration for women in their 40s to get screened, specifically if they had a mother, sister, daughter who had disease.

The task force seems to be justifying their claims around mammograms, saying there is a greater benefit for those at a higher risk than average risk.

Mammogram Debate 6 Years Ago

6 years ago, as the screening guidelines changed from 40 to 50 years old, women everywhere revolted. The guidelines also said mammograms should be done every other year versus yearly. Many government officials, including Congresswoman Debra Wasserman, fought to have the guidelines changed back and they did but now the guidelines are being re-released with the same idea but are now saying women in their 40s should have the "freedom to choose for themselves."

Some would go so far as to say that since the debate 6 years ago, it has become less controversial due to growing evidence of:

  1. Too much screening can lead to anxiety-ridden false-positive results,
  2. Over diagnosis
  3. Over treatment

3-D Mammogram May Be Better Screening Method

Technology around breast cancer screening and mammograms continue to improve. Recent evidence shows 3-mammography as a more accurate and better screening tool for breast cancer. One study showed 3-D mammograms can pick up more breast cancers and lead to fewer callbacks for more testing than 2-D mammography.

Insurance coverage may be jeopardized by new guidelines

Florida Congresswomen, Debra Wasserman Schultz also a breast cancer survivor wrote a very touching piece in the Washington Post regarding her own battle with breast cancer and if not for screening, may not have even caught it. She also makes a great point that these guidelines could lead insurance companies to drop coverage for women under age 50. 

The 2010 Affordable Care Act requires health insurers to pay for screening procedures that the US Task Force recommends strongly, however mammograms have become an exception to this because doctors and American Cancer Society have continued to recommend. 

Other critics of the guidelines are the American College of Radiology who released a statement last week and believe this recommendations will result in thousands of additional breast cancer deaths each year. They deemed these guidelines are not trustworthy. 

A team of radiologists at Loyola University Health System also said the same. 

Breast Cancer in Women in Their 40s

1 in 6 breast cancers occur in women in their 40s. Years of research clearly support the use of annual screening in women starting at age 40.

Samadi's Take

The USPSTF lacks a cancer specialist, radiologist, surgeon or pathologist, and also mentions none of these ways to distinguish indolent from dangerous tumors.

I encourage women everywhere to go to the comment and ask for their reasoning and fight these guidelines. The comment period is open for 30 days and you can start here. 

The guidelines are highly regarded, making this extremely dangerous. They’re not giving women in their 40s firm advice regarding screening. The advice is wishy-washy, of course women need to be informed and make their own decision but these guidelines play a role in that decision making especially for upcoming generations.

  1. They ignore the progress in pathology that has happened
  2. Talk about false-positive tests, their big standpoint on lowering guidelines
  3. Since mammogram screening became widespread in the 1980s, US breast cancer death rate has dropped 35%

The National Cancer Institute announced total # of breast cancer cases in US will rise by 50% by 2030, # of cases per year will be 441,000. 

Is this the time to make guidelines more lax?

If a women and her doctor decide a mammogram is necessary, should she have to worry her insurance will cover it?

Catching cancer early can save costly procedures down the road

Many doctors still recommend yearly screening in women at age 40. The American Cancer Society continues to recommend yearly mammograms in women age 40.

Even though we know early intervention is key to beating this disease, these guidelines will cause women to not be as proactive when considering their breast cancer prevention options and screening.