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Are USPSTF Mammography Guides Backward?

September 9, 2013
Written by: , Filed in: Breast Imaging
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Did the U.S. Preventive Services Task Force (USPSTF) get its mammography recommendations backward?

provocative  new study, published online Monday in Cancer, suggests exactly that. The USPSTF in 2009 recommended screening mammography every two years for women age 50 to 74 and said screening decisions for those younger than 50 should be made on an individual basis. In contrast, the American College of RadiologySociety of Breast ImagingAmerican Cancer Society (of which Cancer is the official journal), and other organizations recommend annual screening for all women beginning at age 40.

Blake Cady, MD, professor of surgery (emeritus) at Harvard Medical School in Boston and one of the authors of the new study, said in a news release from the publisher, Wiley-Blackwell:

The biological nature of breast cancer in young women is more aggressive, while breast cancer in older women tends to be more indolent. This suggests that less frequent screening in older women but more frequent screening in younger women may be more biologically based, practical, and cost effective.

Dr. Cady told HealthDay News, “I would propose that women start screening at age 40.”

The researchers looked at 7,301 invasive breast cancer cases diagnosed at Partners HealthCare hospitals in Boston from 1990 through 1999 and followed the patients through 2007. Of those patients, 609 died from breast cancer. Twenty-nine percent of those who died of breast cancer had received screening mammography within two years of their cancer diagnosis, and 71 percent had not.

“These findings should quiet those who argue that women age 40–49 do not need regular mammography screening,” said Barbara S. Monsees, MD, chair of the ACR Breast Imaging Commission, in a news release. “In fact, these women need annual screening—as do all women 40 and older.”

Despite Dr. Monsees’s admonition, critics did not keep quiet. H. Gilbert Welch, MD, professor of medicine at The Dartmouth Institute for Health Policy & Clinical Practicetold LiveScience that the study told “only half the story” because the researchers did not track screening rates among women who survived. “If, among women who live, 30 percent were screened and 70 percent were not, everyone would agree that screening had no effect,” he said.

Dr. Welch and a colleague conducted a study, published last November in the New England Journal of Medicine, that suggested that mammography was associated with only a small reduction in late-stage cancers but a considerably increased risk of overdiagnosis.

The argument over mammography will not quiet down anytime soon, but the new study in Cancer certainly supports the pro-mammography side. Stay tuned; there will certainly be more research.

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Related CME seminar (up to 24 AMA PRA Category 1 credits™): Chicago International Breast Course and The Society for the Advancement of Women’s Imaging

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