Canadian breast cancer screening guidelines would cost thousands of lives

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New breast cancer screening guidelines by the Canadian Task Force on Preventive Health (CTFOPH), which recommend against annual screening of women ages 40-49 and extending time between screens for older women, ignore results of landmark randomized control trials which show that regular screening significantly reduces breast cancer deaths in these women. While implementation of the CTFOPH guidelines may save money each year on screening costs, the result will be thousands of unnecessary breast cancer deaths.

Hellquist et al and Tabar et al, respectively, the largest and perhaps longest breast cancer screening trials ever performed, proved regular mammograms reduced breast cancer deaths by approximately a third – even in women 40-49. Their exclusion from CTFOPH consideration raises serious concerns about the CTFOPH analysis.

The Canadian guidelines, published in the Canadian Medical Association Journal, largely mirror those released by the United States Preventative Services Task Force (USPSTF) in 2009. The USPSTF approach misses 75 percent of cancers in women 40-49 and up to a third of cancers in women 50-74. An analysis (Hendrick and Helvie) in the American Journal of Roentgenology, showed that, if USPSTF recommendations were followed, 6,500 additional women each year in the U.S. would die from breast cancer.  A similar proportion of Canadian women will likely die unnecessarily each year from breast cancer if the CTFOPH guidelines are followed. 

“Panels without profound expertise in breast cancer screening should not be issuing guidelines. These recommendations are derived from flawed analyses and they defy common sense. Women and providers who are looking for guidance are getting bad advice from both Task Forces,” said Barbara Monsees, MD, chair of the American College of Radiology Breast Imaging Commission.

According to National Cancer Institute data, since mammography screening became widespread in the early 1990’s, the U.S. breast cancer death rate, unchanged for the previous 50 years, has dropped well over 30 percent. Every major medical organization with expertise in breast cancer care, including the American Congress of Obstetricians and Gynecologists (ACOG), American Cancer Society, American College of Radiology, and Society of Breast Imaging continue to recommend that women begin receiving annual mammograms at age 40.

“The Canadian guidelines may significantly impact the ability of women to get a mammogram in their community. The result may be to reverse the tremendous gains made against breast cancer over the last two decades,” said Dr. Monsees.

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Shawn Farley

703-648-8936
American College of Radiology

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