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Study: Personalize Mammography Guidelines

July 5, 2011
Written by: , Filed in: Breast Imaging, Practice Management
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Mammography guidelines should be personalized based on a woman’s age, breast density, family history of breast cancer, history of breast biopsy (if any), and personal beliefs about the potential benefits and harms of screening, according to a new study published today in the Annals of Internal Medicine.

That such a common-sense recommendation will certainly generate controversy constitutes a sad commentary on how the medical establishment has handled the mammography issue in recent years.

The American Cancer Society recommends yearly mammograms starting at age 40. Period.

A year and a half ago, the U.S. Preventive Services Task Force (USPSTF) drew a firestorm of criticism (much to its bewilderment) for bringing some evidence-based nuance to the discussion. It recommended mammograms every two years for women ages 40 through 49 if the patient and her doctor concur, and yearly mammograms for women ages 50 through 74. It made no recommendation for women ages 75 and up because of lack of evidence.

The USPSTF didn’t realize a couple of things. First, the public understandably prefers clarity (“do this; don’t do that”) over ambiguity (“do this, maybe, after you talk to your doctor about it; if you’re over 75 we don’t know what you should do”). Second, its recommendations came across as coldhearted bean-counting with no regard for the feelings or welfare of individual women.

Of course a 40-year-old woman with dense (i.e., low-fat) breasts (a breast-cancer risk factor), a family history of breast cancer, and a strong fear of developing the disease herself would likely have a better overall quality of life if she received annual mammograms. Of course a 50-year-old woman in excellent health, with low-density breasts, no personal or family history of breast cancer, and a personal belief that the hazards of radiation exposure outweigh her risk of developing breast cancer would probably be better off, all things considered, receiving a screening mammogram every two years, or even less frequently.

“Feelings matter too,” said John Schousboe, MD, of Park Nicollet Health Services and the University of Minnesota, both in Minneapolis. He continued:

If mammograms reassure you, then more often is OK. If they worry or bother you, then less frequent may be OK.

Dr. Schousboe, lead author of the study, was quoted in a news release from California Pacific Medical Center in San Francisco. He did point out that the study found yearly mammography not to be cost-effective. Compared with mammography every two years, it was expensive and yielded little additional health benefit, regardless of breast density or other factors.

We’ll see how well common sense plays in the mammography wars. What’s your guess?

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Related seminar: Breast & Women’s Imaging Seminar

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