Many of you may be concerned about recent news reports discussing possible changes in the recommendations for screening mammography. These reports are based on a panel recommendation from the United States Preventive Services Screening Task Force (USPSTF), an independent expert panel sponsored by the United States Department of Health and Human Services Agency for Healthcare Research and Quality. The panel evaluates risks and benefits of different screening procedures. They meet regularly to review all screening tests. In the recent update, they expressed a concern that mammography in women between the ages of 40 and 49 may not be as useful as in older women. These new recommendations took into account the possible positive and negative impact of screening tests. While mammography can detect some breast cancers at an early stage, their worry is that overuse of mammography could lead to unnecessary biopsies, surgeries, and treatments. Some organizations support the new recommendations; some do not. Health Butler is continuing to evaluate the new breast cancer screening recommendations, but for now, we are not in support of the guideline change. Particular critiques of the motivation for the guideline change are discussed below.

Some of the issues bringing the new recommendations into question include:

1. Nobody is sure which cancers will progress and at what rate, so missing an early cancer could have a fatal outcome.
2. One of the downsides the panel noted was that biopsies and other procedures which end up not showing true cancer can cause fear and anxiety. Most women would rather face some anxiety than die of cancer.
3. Women in the younger age groups often have more aggressive cancers and younger families and missing some of these cancers could lead to very bad outcomes.
4. These new recommendations do not adequately address the issue of women with increased breast cancer risk.
5. Many other respected organizations including the American Cancer Society and the Memorial Sloan-Kettering Cancer Center are not endorsing the changes.

Health Butler continues to recommend annual screening mammography for women 40 years of age and older. In addition, all women need to evaluate their own personal breast cancer risk before deciding on a breast cancer screening regimen. Women at increased risk may need earlier and/or more frequent screening mammography, and possibly other screening tests like breast MRI and genetic testing. To learn about breast cancer screening in general, visit http://healthbutler.com/screenings/breast-cancer-screening. To learn about mammography specifically, visit http://healthbutler.com/screenings/mammogram. --Sunday, December 20, 2009