New United States mammogram guidelines ignite debate

Changes to mammogram guidelines in the United States have earned praise from some cancer advocacy groups, attracted scorn from others and appear to have confused much of the public.

On Nov. 16, 2009, the United States Preventative Services Task Force, a 16-member panel of experts appointed by the Department of Health and Human Services, released new guidelines for breast cancer screening. The guidelines recommend that women aged 50–74 have mammograms every two years instead of annually. The most controversial update, however, is the new guideline suggesting that regular breast cancer screening begin at age 50 instead of 40, as was suggested in the old guidelines.

Some critics of the new guidelines say the task force was politically motivated, making changes only to save money as part of US President Barack Obama’s health care reform plan. Others opposed to the changes say they will lead to private health insurers restricting screening reimbursement, as well as Medicaid and Medicare cutting back on coverage for mammograms, which will hurt low-income women.

"I know that some have argued that for the underserved women, screening is their access to the health care system. But that is why we are working so hard to have laws that guarantee access to care for all," Fran Visco, president of the Washington, DC-based National Breast Cancer Coalition, wrote in an email. "The underserved are entitled to the truth just as much as those that are comfortable accessing the health care system. We should put our efforts toward outreach to educate that population about quality and evidence and access, rather than continue to send messages that are incorrect."

For women aged 50–59, one death is prevented for every 1339 women screened for 10 years, the task force concluded. But among women aged 40–49, one death is prevented for every 1904 screened. The task force concluded that this risk is not enough to recommend widespread screening for women in their 40s considering the counter risk of incorrect diagnoses.

"The benefits of implementing the recommendations of the Task Force for women in their 40s include fewer unnecessary biopsies, less overtreatment and the resulting unnecessary toxic and life threatening treatments, cost savings that can be redirected to finding answers that are correct for women in this age group and better understanding by the public about the complexity of breast cancer and the importance of evidence based medical care," Visco wrote.

Though positively received by some cancer support groups, others were quick to denounce the new guidelines. The American Cancer Society, for example, announced it would continue to recommend screening for women in their 40s and claimed the task force did not consider all available evidence. In a press release, Dr. Otis Brawley, the society’s chief medical officer, wrote that "the overall effectiveness of mammography increases with increasing age. But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives. As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: this is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member."