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Controversial New Recommendations for Breast Cancer Screening

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32 Comments

The U.S. Preventive Services Task Force (USPSTF) changed three recommendations yesterday regarding breast cancer screenings. The USPSTF is the leading independent panel of private-sector experts in prevention and primary care and conducts assessments of the scientific evidence for the effectiveness of clinical preventive services, including screening, counseling, and preventive medications.

It is important to note that the recommendations below are for “routine” screening which means screening for any women 40 and beyond. It is also important to note that the recommendations do not recommend against screening for all women over 40. Women who have a family history of breast cancer or other risk factors should talk with their doctor about screening.

1) They recommended against “routine” mammographies for women 40-49.
2) They recommended against teaching women self breast cancer exams.
3) They recommended screening for women 50-74 every two years.

By beginning screening at 40 instead of 50, the USPSTF had moderate certainty that the net benefits were small and that moderate harms from screening remain at any age and that the risks associated with these screenings outweighed the benefits. Risks to screenings include false positives, biopsies, anxiety, overdiagnosis, and exposure to radiation from mammographies.

What are your thoughts regarding these new recommendations? Does knowing that the risks of screening outweigh the benefits play into your opinion? This is an emotional topic. We want to hear from you. We also encourage you to visit the USPSTF recommendation site for more information.

  • Gail

    I heard Susan Love speak last night on this and I think she’s wonderful and right on, so if she is with this recommendation, than it must be ok! Money needs to be put to better use for research/development.

  • Erin Schuster

    The USPSTF thinks there are more risks involved in doing non-invasive mammographies than there are risks involved with doing yearly PAP smears? Seriously? Which insurance company is padding their pockets to say that? As early as some women are diagnosed, this is surely signing their death certificates…

  • http://facebook Kathy Arnold

    I was diagnosed with breast cancer back in 1993 at age 31. It was found by a self exam and I would highly recommend that. Does it find the lumps everytime? No of course it doesn’t but what does it hurt to do one every month?? It doesn’t make any sense to me not to do it. I also had mammograms afterwards every 6 months and several times they seen something and did a biopsy so I would really recommend anyone in my family or my friends to start them at age 40.

  • Jennifer Smith

    I was diagnosed at the age of 47 with a very early stage cancer. I had no family history, no risk factors, no lump, so under the new recommendation I would not have had a mammogram until the age of 50. With a high grade cancer with comedo cells, I probably would have had an advanced stage cancer by that time. I was able to have a lumpectomy and keep my breast. Dr. Nancy Snyderman of the Today Show, speaking in support of this recommendation, stated that is was about the money, about the costs and stated that there was no consideration made to trying to save women’s breasts. What is the emotional and mental cost to women when they lose their breasts to cancer? We have no perfect test at this time, but until we do they should not change the screening age from 40 to 50. I know too many women who were diagnosed in their 30′s and 40′s by self breast exams and mammograms. Dr. Love has always questioned mammograms as a tool and is actively researching for a replacement. Until that technology is developed, is affordable and paid for by insurance companies, she should not be recommending this change. I feel she has a huge conflict of interest and I have withdrawn my support of Dr. Love and the Army of Women. The survival rate for early stage cancer was about 74% in the 70′s, it is now 98% because of increased awareness, self exams and annual mammograms. We should not be considering going backwards. ACS and Komen do not support this recommendation, my support, my advocacy, and my dollars will continue to go to them, as they best represent my daughters and myself.

  • http://www.facebook.com/people/Christopher-Dockens/1418379592 Christopher Dockens

    It is not controversial, it’s a report by some of the most intelligent people in the field crunching numbers. You have to read the whole report, not just pick out key phrases, people formulate opinions based off what they read or hear in the media, not by looking at the source and fully understanding it.

  • Doreen

    I am totally sick and disgusted with the new screening recommendations. I was diagnosed with invasive breast cancer at age 44 by something suspicious on a mammogram. My tumor was so deep it would not have been detected by a breast exam. It was so deep that it probably would not have been felt – it most likely would have spread to my lungs. I did not have a family history of breast cancer.

    I know of far to many women who have been diagnosed with breast cancer in the 20′s, 30′s, 40′s and 50′s – too many women who have lost their battles leaving small children behind with no mother.

    Early detection is the best thing we have for fighting breast cancer right now – why on earth are we going backwards ?? Clearly the people on the panel making this recommendation do not have friends or family that have been diagnosed with breast cancer before age 50.

    Is it really acceptable to lose 3% more women to breast cancer each year due to this change in screening guidelines ? My answer is NO – it is not acceptable … we have to stop this nonsense change.

  • Asya

    When is there too much screening? I was diagnosed with bladder cancer which was found via a cystoscopy – most early bladder cancer has symptoms resembling a bladder infection, should we do cystoscopies on all women who present with bladder infection symptoms?

    Of course in *my* case it was the right thing and I’m happy I was referred to a doctor who figured out it was right to do it, but it seems invasive and unnecessarily expensive to recommend it for all.

  • http://pinkribbons.org Susan Rafte

    At 45 years old, and a 15 year survivor of breast cancer, I am still 5 years away from the newly recommended age for my baseline mammogram. Go figure!
    Although I found my breast cancer by self breast exam at the age of 29 (really the only way to diagnose at that age…I am still upset and on my soapbox that BSE has been claimed to be not worthwhile), I am shocked and outraged by the recent recommendations released by the govt. task force to raise the age of a baseline mammography to 50. After reading the opposing responses by American Cancer Society, MD Anderson Cancer Center and Komen of this recommended change, my first question is ‘Who was on this task force?’ When the big players aren’t asked to be present on this type of task force, it really makes me wonder — Was the room filled with a bunch of insurance lobbyists?
    Dr. Brawley of ACS made a valid point by saying that this recommendation is suggesting the lives of the women between 40-49 aren’t as valued as those at 50+. The ratio is just slightly different – at 50 1/1300 and at 40 1/1900 will be diagnosed. So basically the task force is saying those of us under 50 really aren’t worth the fuss (and go to the previous insult of discarding BSEs – those of us under 40 aren’t even worthwhile).
    I understand that BSE and mammography are not fail proof and create false positives, but until there is something better to replace these detection methods, don’t throw the baby out with the bath water! Is there any benefit to removing BSE and now changing too soon the mammography piece of the not so perfect early detection process, before a more perfect solution is in place? Is it going to save us money or expedite the research (and even if it does, does that justify the breast cancers that will be missed and probably lives lost of those under the age of 50 by prematurely making this change)? Until we have the better solution, let’s work with what we do have and let’s continue to educate both the patients and the medical community to help work around unnecessary procedures.
    I am all in favor of searching for both better detection, prevention and best of all – a cure, but until then let’s not lose the footing we do have by missing breast cancers of those under 50.
    I am certain we all can make a list of people we know who were diagnosed under the age of 50. Unfortunately a lot of times it is in this age group that the more aggressive tumors appear and because of that, I am certain we also have a list of those who died of breast cancer before their 50th birthday!
    I guess we just aren’t worth the fuss.

    Sincerely,
    Susan Rafte
    Executive Director
    Pink Ribbons Project

  • Kristen

    I am outraged by this. The scientific evidence PROVES that early detection saves lives. There is a reason that there has been a decrease in deaths from breast cancer and an increase in survival rates in the last 10 years and that is due to self exam and EARLY DETECTION. I am a nurse and I cannot tell you the literally hundreds of patients that I know that cancer in their thirties and found out due to early mammogram and self exam. IMPORTANT! The ONLY reason that I can see this happening is due to the new government health care. I read in the Wall Street Journal today that the Federal panel who recommends decrease in mammograms and no self exam stated they expect to save 5 BILLION DOLLARS a year by doing this!!! THIS IS A SIGN OF THINGS TO COME!!! For everyone who wants the government involved in your health care….be careful what you want you might just get it!!!!!!!!!!

  • Facebook User

    Yes, I agree. Even though it might have been out of sincere intention, I was pursued-almost to the point of harrassment-concerning having the mammogram. Something just didn’t ‘feel right’ so the harder the medical people pushed me, the more I ‘dug my heels in’ (so to speak) and resisted. My ‘choice’ was not met with any respect, either. Instead, a kind of ‘fear tactic’ was used. It was SUCH a horrible experience, that I never went back. NOW, 3 years later, I see this reported on ?ABC News and here. Yes, certain people at high risk should be checked regularly and a person should always follow their ‘gut instincts’ concerning their health because NO ONE can do that better. Looking from the ‘outside’, just watching TV, SO MANY commercials are for medicines and I think this instills a ‘fear’ into the public. I think this should be changed-along with the volume being raised during commercials. What? They think that because it’s louder, we’re going to buy the product? Quite frankly, they’re a pain in the arses, hehehe. (Just thought I’d whine about that, also, lol.)

  • http://Facebook Judy Tatum Lane

    I was diagnosed with breast cancer before the age of 50, and every year when I participate in the “Strides Against Breast Cancer” walk, I look at the survivors, some still in high school. Most below the age of 50, so many with young toddlers. This year the theme was “Birthdays”. All survivors told how many years since their diagnosis, it was added up and came to 534 years and birthdays celebrated. What a small number and what few future birthdays would have been celebrated if these women had waited until 50 to begin getting mammograms. I began at the age of 36 at the recommendation of my doctor due to fiber cystic disease. It saved my life. And any woman who has had breast cancer should have an ultrasound as well.

  • http://www.facebook.com/people/Benjamin-Reed/1008814303 Benjamin Reed

    My concern is that the new recommendations are a statistically-based approach to improve mass results of an entire industry. It seems like a good way to overlook and potentially harm individual lives that could be saved or improved by erring on the side of “over-treatment”.

  • Catherine McCord

    I am outraged at this latest statictically based approach to Breast Cancer. Early detection through self exam and mammography saved so many lives in the last decade.
    I am in my 40th year and with my family history, being my mother having a mastectomy at 48 years old and dying at 54years of age in the early 80′s I have always used self examination. Now at 40 it is recommended that I get an annual mammogram. I am hesitant about getting a yearly mammogram but I will work in conjuction with my GP using self breast examination and my GP’s opinion as to whether I will get a mammogram each year. I may leave it for every second year. But at the moment in Ireland the age for getting yearly mammograms is 50 years of age which maybe too late for me and certainly was too late for my best friend who had a mastectomy last year at the age of 43.
    Women should use their intuition, common sense and education and if each woman feels they need a yearly mammogram, so be it. Feck the cost. If it saves one person’s life or gives one person an extra 10 years on their lives, Feck the cost and the statistical reports.
    These reports and the highlighting of same in the media have set back so much hard work and advertising pro Breast Check 20 years or more.
    People should think before they set pen to paper, or touch a keyboard.

  • Lori Todd

    I’ve looked at the credentials of the 16 panel task force. There are 2 who work for insurance companies.

    Not a single Oncologist, or Breast Cancer specialist on the Task Force.

    1. State Epidemiologist
    Colorado Department of Public Health and Environment
    2. Professor of Biomedical Informatics, Arizona State University
    3. PhD. Dean, College of Public Health
    Distinguished Professor
    University of Iowa
    4.Director of the Division of General and Community Pediatrics, Cincinnati, OH
    5.Director, Maternal-Fetal Medicine and Women’s Health Services Research
    Cedars-Sinai Medical Center, Los Angeles, CA
    6. Insurance company: Group Health Cooperative
    7. Insurance company : HealthPartners
    8. Professor, School of Nursing
    Medical College of Georgia, Augusta, GA
    9. Professor in Nursing
    10. Health Management, and Economics
    11. VA Medical Center

    Here’s the link and a copy & paste of it’s members:
    http://www.ahrq.gov/clinic/uspstfab.htm#Partners

    Members of the USPSTF
    The USPSTF comprises primary care clinicians (e.g., internists, pediatricians, family physicians, gynecologists/obstetricians, and nurses). Individual members’ interests include: decision modeling and evaluation; effectiveness in clinical preventive medicine; clinical epidemiology; the prevention of high-risk behaviors in adolescents; geriatrics; and the prevention of disability in the elderly.

    Current members of the Task Force are listed below. They have recognized expertise in prevention, evidence-based medicine, and primary care.

    Bruce N. Calonge, M.D., M.P.H. (Chair)
    Chief Medical Officer and State Epidemiologist
    Colorado Department of Public Health and Environment, Denver, CO

    Diana B. Petitti, M.D., M.P.H. (Vice Chair)
    Professor of Biomedical Informatics
    Fulton School of Engineering
    Arizona State University, Tempe, AZ

    Susan Curry, Ph.D.
    Dean, College of Public Health
    Distinguished Professor
    University of Iowa, Iowa City, IA

    Allen J. Dietrich, M.D.
    Professor, Community and Family Medicine
    Dartmouth Medical School, Hanover, NH

    Thomas G. DeWitt, M.D.
    Carl Weihl Professor of Pediatrics
    Director of the Division of General and Community Pediatrics
    Department of Pediatrics, Children’s Hospital Medical Center, Cincinnati, OH

    Kimberly D. Gregory, M.D., M.P.H.
    Director, Maternal-Fetal Medicine and Women’s Health Services Research
    Cedars-Sinai Medical Center, Los Angeles, CA

    David Grossman, M.D., M.P.H.
    Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative
    Professor of Health Services and Adjunct Professor of Pediatrics
    University of Washington, Seattle, WA

    George Isham, M.D., M.S.
    Medical Director and Chief Health Officer
    HealthPartners, Minneapolis, MN

    Michael L. LeFevre, M.D., M.S.P.H.
    Professor, Department of Family and Community Medicine
    University of Missouri School of Medicine, Columbia, MO

    Rosanne Leipzig, M.D., Ph.D
    Professor, Geriatrics and Adult Development, Medicine, Health Policy
    Mount Sinai School of Medicine, New York, NY

    Lucy N. Marion, Ph.D., R.N.
    Dean and Professor, School of Nursing
    Medical College of Georgia, Augusta, GA

    Joy Melnikow, M.D., M.P.H.
    Professor, Department of Family and Community Medicine
    Associate Director, Center for Healthcare Policy and Research
    University of California Davis, Sacramento, CA

    Bernadette Melnyk, Ph.D., R.N., C.P.N.P./N.P.P.
    Dean and Distinguished Foundation Professor in Nursing
    College of Nursing & Healthcare Innovation
    Arizona State University, Phoenix, AZ

    Wanda Nicholson, M.D., M.P.H., M.B.A.
    Associate Professor
    Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD

    J. Sanford (Sandy) Schwartz, M.D.
    Leon Hess Professor of Medicine, Health Management, and Economics
    University of Pennsylvania School of Medicine and Wharton School, Philadelphia, PA

    Timothy Wilt, M.D., M.P.H.
    Professor, Department of Medicine, Minneapolis VA Medical Center
    University of Minnesota, Minneapolis, MN

    Role of AHRQ Staff:
    The work of the USPSTF has helped establish the importance of including prevention in primary health care, ensuring insurance coverage for effective preventive services, and holding providers and health care systems accountable for delivering effective care.

  • Lori Todd

    The task force sets the policies guidelines that Insurance companies will follow. And again, not a single Oncologist, Breast Cancer Specialist among the 16, but THERE ARE 2 WHO WORK FOR INSURANCE COMPANIES.

  • Kristen

    Well said Lori Todd!!!! This is about rationing and not about what is best for the women of this country. Like Sanjay Gupta said “Essentially what this task force is saying is that early mammography saves lives…just not enough lives”!!!!! This sounds like socialized medicine to me. To everyone who says that mammography harmed them psychologically due to false positive… there are HUNDREDS that mammography saved! You have the right to your opinion, just dont take away my right to have a mammography every year starting at 40 if that is what I want to do. And by take away my right, I mean that if my insurance doesnt pay for early mammography I wont be able to afford one…hence I am out of luck!! This is clearly a case of what is to come in Government health care…. what is next… no more Level I Trauma Centers because the cost is too much compared to the number of lives that are saved!!!

  • http://carolinemfr.blogspot.com Caroline Ronten

    I had thyroid cancer in 1981 and then a benign breast lump in 1984 at age 23 so I have been considered high risk. I have had mammograms since then yearly and would have them under the proposed rules. I also believe there are two sides to the story – test often and find things earlier but cause more costs and scanxiety on the part of the patient or scan less often and only test at symptoms but run the risk of finding something later stage. Which is best? Well, that is the problem. I think it depends on the individual patient. Some people don’t want the tests, others do. Its their choice. Unfortunately what we have here is a case of rules for a group determining individual decisions. Patients can still opt out of the tests individually but their insurance companies could ‘opt them out’ simply because they can and want to save money.

  • A Leslie

    I understand screening in this group can give false positives and negatives.

    However consider this: Just turned 40, no history of breast cancer or any other indicators, incredibly fit with healthy eating habits and good lifestyle balance. Diagnosed with triple negative BC which was node positive and is now metastatic. Average life expectancy 2-4 years.

    I think if you want to take away things like scans and self examination then make damn sure you replace them with something a lot more effective before you do.

    I don’t agree with discouraging women from self-exam either. If its believed this tool is not taught effectively then find a way to better educate.

  • A. K. Lupo

    If I had not known about self-exams, I shudder to think what my story might be. At 53, six weeks after a “clean,” routine mammogram, I found a lump. Surgery, chemo, radiation followed. Why ON EARTH would they advocate that women not routinely exam themselves?!

    There is NO history of breast cancer in my family – none, zero, zip…now, of course, there’s me. What’s the wisest course of action for my sisters, daughters and granddaughters? You can bet I’ll continue to advise self-exams, routine mammograms and annual check-ups!!!!

    Knowledge is power.
    Seven Year Survivor

  • Jennifer

    I agree with what has been said already. At the age of 47, I had a routine mammogram. We found cancer. I have since been connected with hundreds of other breast cancer patients via a large online forum, NONE of whom is over 50.

    Many of my friends have died from it because they did not get early detection. EARLY DETECTION MAMMOGRAMS SAVES LIVES.

    In case that wasn’t clear, let me say it again:

    EARLY DETECTION MAMMOGRAMS SAVES LIVES.

  • http://www.facebook.com/people/Teresa-Wiersteiner-Ansell/1490921023 Teresa Wiersteiner Ansell

    I think a lot of women in their 40s are going to die from breast cancer. My sister had a lump in her right breast that the doctors were “watching”. She had been having drainage from her nipples for a couple of years and more than one doctor told her it was due to clogged milk ducts. When my sister went back to have the lump in her breast checked again – they found a lump in her other breast that was Stage 3 breast cancer. She was in her mid 40s. She had thyroid cancer two times after that and I am happy to report she is a survivor.

  • Sally

    Contrast: my mum, 61, cancer detected by routine mammogram when too small to be felt by self-exam. My friend, 37, larger cancer detected by self-exam. If they had both followed advice not to self-test only one of them would be alive by now but as it is, both of them have had their lumps removed and are in treatment. I don’t know how much more obvious it can be that self-testing saves lives.

  • http://marijolamarche.wordpress.com/ Mari-jo Lamarche

    I’m turning 40 in 11 days and will definitely go for my first mammography ASAP! I really feel it’s my responsability to do so. You know, just in case…
    Mjo

  • Jeremy

    I’m not a fan of the recommendations for a variety of reasons, but the recommendation to NOT self-exam is just silly. It costs nearly nothing to instruct people on proper self-exam and can be done at ANY age. Male or female, if anything doesn’t feel right, find someone who will listen.

  • katouza

    I am still fighting for my life since I have been diagnosed with stage 4 breast cancer, I have been telling all my friends how to consistently do the self exams and request their doctors to get a baseline MRI if they have family history or dense breast that cannot be screened with mammogram. Hearing these recommendations seem to me very negligent and makes me mad.
    The current statistics show that high percentage of women will have breast cancer and given that it is such a aggressive and deadly desease I feel that as women we need to take charge of our health, make sure proper screening is done, fight back such guidelines and make the doctors and insurance componies focus on a cure.

  • Yvonne

    I was dignosed at 44. I found the lump by self-examination. After treatment I had yearly mammography until the surgeon suggested I had them every 18 months as she didn’t want me to be subjected to too much radiation. I am now 7 years post diagnosis and will, from next year, be put on the routine 3 yearly mammography programme which is recommended in this country, the UK.
    My conclusion is that self-examination is crucial and definitely should be promoted, mammogramography should be performed at safe intervals which are surely more than one year.

  • Sharon

    I’m seeing little of this in the media. If women and breast cancer organizations don’t stand up against these new guidelines then we only have ourselves to blame when an additional 3% of American women die each year. Where are the campaigning survivors of the 3-Day and Race For The Cure in all this? Stop drinking the Kool-Aid and realize this is the begining of socialized medicine.

  • http://livestrong.org Brooke McMillan (LAF Staff)

    Sharon- Thankfully, this was plastered all over the media yesterday. So many women and organizations have spoken out against the recommendations. My guess (and hope)is that the news coverage will continue today.

  • http://www.ararecancerjourney.blogspot.com Kathy Seeley

    I was diagnosed 3 weeks after my 40th birthday with a very rare form of a gladular cancer, which was located in my breast. It’s called Adenoid Cystic Carcinoma of the breast. At the time, there was no history of cancer on either side of my family. Without early screenings, I would not be here today.

    I am furious at these recommendations. Changing the ages for mammographies is bad enough, but to also discourage women from self breast examinations is nothing short of medically irresponsible, if not just plain stupid. I wonder how many people on that task force have family members who were diagnosed between the ages of 40 and 49. None, I would guess, as I’m sure the members were carefully selected. The politics of the healthcare system in this country never ceases to amaze me.

  • Jason

    There aren’t many people disputing the data here. Nor do I see anyone advocating screens done from age 20 on. That would also save lives. So would routine screening for every disease that is treatable if caught early. Where do you draw the line? I also think it is notable that there are 9 women on the task force. I find it unlikely that they would be making this recommendation without feeling that it truly the right thing.

  • Marcie

    I co-facilate a cancer support group. There has been ladies in their 30′s with it. My mother died in her mid 50′s. I found my breast cancer by self exam. Let the analysists get it early in life and they will change their decisions and decide stats aren’t that important. But of course they won’t find it will they? They aren’t allowed self exams or mammo’s, so it won’t be until their autopsy that the family will know they died from breast cancer.

  • Deborah

    I’m Australian and mammograms were always targeted at women 2 yearly from 50.
    I have a friend with breast cancer and made the difficult decision last year not to have mammograms.
    In my opinion, they carry too much risk.
    More and more damning evidence is being released every year.
    Remember doctors usually only tell us half the story – if you want an honest assessment of a test, its risks and benefits, you have to do your own research and ask lots of Q’s.
    The Nordic Cochrane Institute were so concerned at the incomplete information being given to women they produced their own leaflet, “The risks and benefits of mammograms” – available at their website.
    **Every woman should read that information leaflet.
    There was also more worrying research released in March 2010 and printed in the BMJ…data taken over 10 years was examined – Danish women 55-72 – one group having mammograms, the other unscreened. The screened group had a 1% drop in mortality from breast cancer. The unscreened group had a 2% drop in the death rate! More screened women died from breast cancer!
    There is another side to cervical screening as well – a rare cancer and massive, harmful and very profitable over-treatment caused by an unreliable test that produces lots of false positives. (and some false negatives)
    Anyone interested in reading up on women’s cancer screening should go to Dr Joel Sherman’s Medical Privacy blog and under women’s privacy issues, you’ll find some amazingly informative medical articles….the stuff they keep from us!
    Clinical breast exams are not recommended by our doctors either – they don’t bring down the death rate, BUT cause biopsies and some believe they are a risk factor for cancer.
    Breast exams – same thing…
    What’s left? Isn’t it strange that we now think we should be doing something?
    I’ve decided to follow Dr Joan Austoker’s breast awareness program – simply taking note of the look and shape of my breast in the mirror after I shower…
    Breast cancer is a common cancer and a real concern, but at the end of the day leading a healthy lifestyle and being watchful for changes and responding promptly is all we can do.(IMO)
    If a test is more likely to harm us, than help us, what’s the point?