Women in their 40s should not get routine mammograms for early detection of breast cancer, according to updated guidelines set forth by the U.S. Preventive Services Task Force.

More controversy is stirring involving a very important screening test for women. Mammography has been under a lot of criticism for decades, and now even more since a new set of guidelines has been institiuted.

According to updated guidelines set forth by the U.S. Preventive Services Task Force (USPSTF), women in their 40s should not get routine mammograms for early detection of breast cancer. They recommend that before having a mammogram, women ages 40 to 49 should talk to their doctors about the risks and benefits of the test. For women ages 50 to 74, it recommends routine mammography screenings every two years. Risks and benefits for women age 75 and above are unknown, it said.

These claims are not new according to Julietta Patnick, the director of cancer screening programs for the British National Health Service. Conventional wisdom about breast cancer screening is under sharp attack in Britain, and health officials have gone so far as to rewrite informational flyers about mammography overstating the benefits of screening and leaving out information about the potential harm.

All of this hub-bub is based on research studies done in Sweden and Norway. The studies indicated that most breast tumors will never threaten a woman’s survival and will undergo spontaneous regression before becoming clinical disease. While roughly 15 percent of women in their 40s detect breast cancer through mammography, many other women experience false positives, anxiety, and unnecessary biopsies as a result of the test, according to data.

A 2006 analysis by an independent research and independent center based in Copenhagen found that for every 2000 women age 50-70 who have had mammogram screening for 10 years, one woman will be saved from dying of breast cancer, while 10 will have their lives turned upside down from anxiety and being unnecessarily over treated. Experts agree that under a microscope, slow growing cancers do not look different than more aggressive cancers, so it’s impossible to determine which ones can be left untouched.
These recommendations from the USPSTF come with strong opposition.

“This will increase the number of women dying of breast cancer. Women in their 40s have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me…” said Dr. Bernardine Healy, former National Institute of Health (NIH) director.
According to the American Cancer Society, Women should have annual mammograms beginning at age 40. Other organizations and medical experts agree with keeping the old guidelines. Their attitude being that even saving one life is worth testing everyone.
Others fear insurance coverage of mammograms could be dropped based on the new recommendations. Some Republicans say the guidelines are the first changes toward government-run health care rationing.

While cancer experts may not all agree with the task force’s guidelines, the bottom line for women regardless of age is to discuss the pros and cons with their physician and make a screening choice based on individual needs. Until we develop predictive markers to determine which cancer cells will regress and which will be more aggressive, women and their doctors need to have an open discussion on what’s best for them.

References: 2009 Breast Cancer Symposium. “Majority of Overdiagnosed Lesions Would Spontaneously Regress in the Absence of Screening”, p. 16.
Rabin, R. The New York Times, “Benefits of Mammogram Under Debate in Britain”, March 30, 2009.
Fox News. “Former NIH Chief: Ignore Government’s Mammography Recommendations”, Nov. 22, 2009.

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