Montclair Breast Center Response to Changes to USPSTF Mammography Guidelines
Since 1990, mammography screening for women starting at age 40 has lowered the death rate from advanced breast cancer by 30% in the US. This death rate had been otherwise unchanged for the preceding 50 years. In fact recent research from Sweden has shown decreased death rate among women in their 40s by over 40%. Early detection has also allowed women the option of less radical/invasive treatments, which has helped to improve the quality of life of those women who have been diagnosed with breast cancer.
The United States Preventive Services Task Force (USPSTF) recently announced that it was changing its guidelines for mammography, which we believe could reverse the declining death rate and cause more women to need more aggressive surgical therapy as well as chemotherapy. The task force no longer recommends mammography for women 40-49 of average risk, recommends biennial (every 2 years) screening for women 50-74, and recommends against teaching women about self breast examination. It also concluded that there was insufficient evidence of any benefit of mammography for women 75 and older, that there was insufficient evidence for the benefit of clinical breast exam as well as digital mammography and Magnetic Resonance Imaging (MRI) of the breasts.
In agreement with the American Cancer Society as well as numerous additional organizations, Montclair Breast Center continues to recommend a yearly screening mammography and clinical breast exam beginning at age 40 for the average risk patient. For higher risk women, it is potentially recommended that this screening starts earlier.
There is universal agreement that screening mammography saves lives. The USPSTF acknowledges that there is a 15% reduction in the death rate from breast cancer in both women age 40-49 and 50-59 who participate in yearly screening mammography. However, the USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile, but screening 1,904 women in their 40s to save one life isn’t worthwhile. We would argue that all lives are worth saving.
In fact recent data has shown that about 17% of breast cancer deaths occurred in women diagnosed in their 40s. The USPSTF at this point is really recommending against all breast cancer screening methods for women in their 40s yet they state that the ten-year risk for breast cancer in a 40 year old woman is 1 in 69. We believe it is important for women to understand that the USPSTF is incorrect in its assumption that loss of life can be minimized if only high risk women get screened in their 40s, because 75% of all breast cancers occur in women who are not at high risk. How could anyone try to justify not screening these women?
At Montclair Breast Center, we acknowledge and understand that mammography has its limitations. But we feel the USPSTF seems far too concerned with “harms” of screening mammography, such as the discomfort of the exam, anxiety over additional views, ultrasounds, biopsies, and over-treating less aggressive breast cancers. We believe that the majority of women understand that mammography is not perfect and they are willing to accept these false positives in order to maximize the ability to find cancer at the earliest, most treatable/curable stage. In fact the USPSTF did not evaluate the personal harm, anxiety, and financial costs of treating breast cancer diagnosed at a later stage in comparison to early stage.
As for the annual vs. biennial screening in the 50-74 year range, research has shown that cancers are smaller and found at an earlier stage when people are screened annually. We would rather not give cancer two years to grow and possibly metastasize (spread) before looking for it.
In summary the USPSTF has rejected numerous scientifically sound research studies for their own study without any of their research being scientifically evaluated by others outside their group. At Montclair Breast Center we pride ourselves on the fact that the majority of our patients diagnosed with breast cancer are diagnosed with Stage 0 or Stage 1 (early detected) breast cancer. That ability is based not only on our specialty training, experience, and state of the art technology, but also on the initial premise that all women 40 and over have yearly screening mammography and clinical breast examination.
RELATED ARTICLES:
Joint Statement from the American College of Radiology and Society of Breast Imaging
SPSTF Mammography Recommendations Should Be Specifically Excluded From Health Care Reform Legislation
http://www.acr.org/HomePageCategories/News/ACRNewsCenter/ExcludedUSPSTFRecsFromHCR.aspx
RSNA refutes proposed guidelines on breast screening
http://www.healthcareitnews.com/news/rsna-refutes-proposed-guidelines-breast-screening