New Arguments about Screening for Breast Cancer

The US Task Force on Protective Services has just come out with new recommendations (published in The Annals of Internal Medicine) about breast cancer screening, and those guidelines have raised a huge storm of protest down south.   

According to these new proposed guidelines (which many, much more politicized organizations have disavowed, by the way): 

   average and low-risk women between the ages of 40 and 50, who up to now had been advised to get annual mammogram screening, are now advised that they don’t need mammogram screening at all;  

   women between 50 and 74 are advised to get mammogram screening only every 2 years as opposed to every year previously;  

   women over 74 have been told that there is just not enough evidence to tell them what to do, and 

   all women are advised that regular breast examinations are not needed since there is little evidence, according to this expert panel, that regular breast examination saves lives. 

All of which is why some American experts and consumer advocates are loudly proclaiming that with the reduction in mammogram screening that’s bound to ensue, there will be a huge upsurge in breast cancer deaths under these recommendations. 

So how likely is that to happen? 

No one really knows, of course, but I think it’s unlikely to lead to a huge upsurge in deaths from breast cancer, and that must be balanced by the pretty sage assumption that these guidelines might improve the lives of millions of women, because there are several problems with mammogram screening, including especially these:  

   1) Although nearly everyone agrees that mammogram screening saves lives if done on appropriate groups, there is still a very real and lively debate among the experts as to what age that benefit kicks in at, specifically about whether screening mammograms in women between 40 and 50 save enough lives to justify the huge costs involved in screening so many women in that age group (the vast majority of European countries, for example, don’t offer this service to women under 50),  

   2) Mammograms pick up a huge number of changes that look suspicious to the mammographer but which don’t end up being malignant (“false positives”), but nonetheless, all such findings lead, not surprisingly, to huge anxiety and needless and potentially problematic “further investigation” (biopsies, which can lead to scarring and infection), and  

  3) Something we’re becoming increasingly aware of, namely that mammograms pick up some “non-aggressive” malignancies that grow so slowly (or even regress) that they would never matter to that patient (that is, the person with that cancer is much more likely to die of an entirely unrelated condition), yet because they’re cancerous, those malignancies are all removed with all the attendant risks that surgery (and often further treatment, too) carries. 

These guidelines are applicable only in the US, of course, but women all over the world are thinking about them, and about the guidelines that apply to where they live. 

Bottom line: guidelines are only recommendations for a patient and their doctor to think about, but which they don’t have to follow. 

As with everything in this business, educate yourself as best you can, and then make the decision that makes the most sense to you, knowing, I’m afraid, that there is no formulaic answer.