The US Preventative Services Task Force released new recommendations that are very controversial at the least. Based on existing studies and scientific method, they have suggested that too much mammogram screening, clinical breast exam and self breast exam may cause unnecessary anxiety and invasive testing to actually detect a “significamy number of breast cancers”. I disagree and so do many experts and governing organizations.
The precise age at which the benefits from screening mammography justify the potential harms is a subjective judgment and should take into account patient preferences. Clinicians should inform women about the potential benefits (reduced chance of dying from breast cancer), potential harms (for example, false-positive results, unnecessary biopsies), and limitations of the test that apply to women their age. Clinicians should tell women that the balance of benefits and potential harms of mammography improves with increasing age for women between the ages of 40 and 70.
Generally, I recommend that women do monthly self breast exams, have yearly clinical exams (such as by a physician) and have yearly digital mammogram. High risk women should have a more intensive surveillance plan. The key to successful treatment is early detection, and every breast cancer that we can detect earrly is a benefit to that woman. Any decrease in screening will only contribute to more late or missed diagnoses and we will lose out in our battle to get ahead of this common and miserable disease. Let’s look at other ways to save money in healthcare rather than less prevention and less early detection of cancer.
Recommendations of Other Organizations:
Numerous organizations have provided breast cancer screening recommendations. These recommendations are summarized below. All recommendations are for women not at increased risk for breast cancer.
In 2003, the American Cancer Society recommended annual mammography beginning at age 40 years, annual CBE after the age of 40 years (25). It does not recommend MRI for women at average risk for breast cancer and states that there is insufficient evidence to recommend BSE.
The American Medical Association, in 2002 (26), and the National Comprehensive Cancer Network, in 2009 (27), have made recommendations similar to those of the American Cancer Society, except for the inclusion of a positive recommendation for BSE.
The American Academy of Family Physicians has endorsed the USPSTF recommendation on breast cancer screening in the past (28). The American College of Physicians recommended in 2007 that screening mammography decisions in women aged 40 to 49 years should be based on individualized assessment of risk for breast cancer; that clinicians should inform women aged 40 to 49 years about the potential benefits and harms of screening mammography; and that clinicians should base screening mammography decisions on benefits and harms of screening, as well as on a woman’s preferences and breast cancer risk profile (29).
In 2001, the Canadian Task Force on Preventive Health Care recommended mammography every 1 to 2 years beginning at the age of 40 years and recommended CBE as part of a periodic evaluation (every 1 to 3 years) for women aged 50 to 69 years (30). It does not recommend BSE.
In 2003, the American College of Obstetrics and Gynecology recommended mammography every 1 to 2 years for women aged 40 to 49 years and annually after the age of 50 years (31). It recommended CBE for all women and noted that BSE can be recommended.
In 2009, the World Health Organization recommended mammography every 1 to 2 years for women aged 50 to 69 years, but does not recommend CBE or BSE (32).