Breast Cancer Screening Issue Remains Unresolved

Dom Nicastro, March 26, 2010

The co-chair of the ACR Breast Imaging Commission calls the US Preventive Services Task Force (USPSTF) mammography guidelines "atrocious" and a two-decade step backward for women's healthcare.

Carl D'Orsi, MD, co-chair of the ACR Breast Imaging Commission, says, "What those guidelines have done is picked women's healthcare up and put it back 20 to 25 years when the mortality from breast cancer was 30% higher."

The USPSTF guidelines, released in November, suggested that women should not be required to start breast cancer screenings at 40. Instead, the task force said women should decide whether to get screened at 40 only after discussing the pros and cons with their physician. Routine screening should start at 50, according to the USPSTF.

The Annals of Internal Medicine, the journal that published the new recommendations, backed the changes in an editorial last month, saying women need to understand the benefits and harms that come with screening.

"Nearly everyone knows [or is] someone whose breast cancer was found on a mammogram," Annals wrote. "Many perceive that the mammogram 'saved a life.' Unfortunately, only a fraction of abnormalities initially detected on mammography and subsequently treated truly represents a life saved rather than unnecessary or premature treatment."

Many women also die despite screening and early detection, Annals wrote, and there are unintended risks that go along with screening.

"Breast cancer prematurely claims the lives of many, but it is wrong to mislead women about the effectiveness of current screening methods," Annals wrote. "Women deserve to make decisions about screening for breast cancer armed with the best available information about potential benefits and harms."

However, D'Orsi says changing mammography practices will put women at risk and won't be realized for years.

The Annals said those who disagree with the USPSTF recommendations are relying on emotion rather than science, but ACR and the Society of Breast Imaging (SBI) wrote in a statement, "This ignores the fact that different conclusions can be reached based on the same data. The USPSTF admits that its members were not unanimous in endorsing these recommendations."

ACR and SBI still say women 40 and older should automatically be screened for breast cancer, and women over 50 should continue with annual exams, said Carol Lee, MD, chair of the American College of Radiology Breast Imaging Commission, in a written release.

Lee and others said that the USPSTF recommendations were based on shoddy science and fly in the face of evidence. Since mammography screening began in 1990, the mortality rate from breast cancer dropped by 30%. Prior to screening women, the death rate had been unchanged for 50 years, according to ACR.

ACR said the USPSTF based its recommendations to reduce breast cancer screening on "conflicting computer models." It also based them on the controversial view that the parameters of mammography screening change abruptly at age 50.

"There are no data to support this premise," the ACR said.

Dom Nicastro Dom Nicastro is a contributing writer. He edits the Medical Records Briefings newsletter and manages the HIPAA Update Blog.
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