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Sweeping new US breast cancer guidelines released recommend
against routine mammograms for women in their 40s, and suggest
women 50 to 74 only get a mammogram every other year.
The new guidelines by the US Preventive Services Task Force, an
influential panel of independent experts, would sharply curtail the
number of breast mammograms done in the United States, sparing
women the worry of false alarms and the cost and trouble of extra
tests.
But US cancer experts say the altered schedule may mean more women
will die from breast cancer.
The guidelines, published in the Annals of Internal Medicine, are
based largely on computer projections from six independent research
groups in the United States and Europe.
They predicted that screening women 50 to 69 every other year will
catch nearly as many breast cancers - 81% - while producing half as
many false positive results.
"Although the USPSTF recognizes that the benefit of screening seems
equivalent for women aged 40 to 49 years and 50 to 59 years, the
incidence of breast cancer and the consequences differ," the task
force, sponsored by the US Agency for Healthcare Research and
Quality, wrote.
The group's last recommendations in 2002 called for routine
mammograms every one to two years for all women older than
40.
Now, they recommend no routine screening for women in their 40s,
and instead suggest these women decide themselves when to start
after weighing the risks and benefits.
"This is not a recommendation against mammography for women in
their 40s," said Dr Diana Diana Petitti, a professor of biomedical
informatics at Arizona State University in Phoenix, who spoke on
behalf of the task force.
Petitti said for women in their 60s, the benefits of screening
clearly outweigh the harm.
Letting cancer lie
The panel said there is not enough evidence to say women over 74
benefit from mammograms because at that age, screening may be
detecting cancers that will not ever kill a woman.
The guidelines also say there is not enough evidence to prove that
women benefit from self breast exams, or even if they help if
doctors do them.
Dr Daniel Kopans, professor of radiology at Harvard Medical School
in Massachusetts, said the new guidelines are scientifically
unjustified and will condemn women ages 40 to 49 to unnecessary
deaths from breast cancer.
"If you look at their guidelines, they are saying, 'Don't examine
yourself, don't let anyone else examine you, and don't get a
mammogram.' Where does that leave you? It leaves you waiting to
have a big cancer that you can't ignore any more," Kopans said in a
telephone interview.
The American Cancer Society will disregard the guidelines.
"The American Cancer Society will continue to recommend that women
of average risk of breast cancer start screening at age 40 and get
screened every year," Dr Len Lichtenfeld, the group's deputy chief
medical officer, said in a telephone interview.
Dr Carol Lee, chair of the American College of Radiology Breast
Imaging Commission, said in a statement the recommendations ignore
the valid scientific data and place a great many women at risk of
dying unnecessarily.
Lee and Lichtenfeld said they fear insurers - both private and
public - will use them to pare back health costs.
"These new recommendations seem to reflect a conscious decision to
ration care," Lee said, although Petitti said cost was not a factor
in their decision-making.
Most countries have settled on a plan for regular mammograms after
age 40 or 50 in the hope of detecting tumours while they are small
and easily cured.
Breast cancer is the top cancer killer of women globally, killing
500,000 annually.
