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Breast Cancer Screening Guidelines Statement

The United States Preventive Services Task Force (USPSTF) updated their breast cancer screening guidelines in the Annals of Internal Medicine on November 17, 2009 and this has created quite a controversy.

After careful review of this report and the 2 accompanying studies, the Breast Cancer Multidisciplinary Conference and the Northwest Hospital Committee on Cancer have unanimously agreed to stand by the longstanding guidelines established by the American Cancer Society. The following national and local groups have also come out against the new USPSTF guidelines: American Cancer Society, National Cancer Institute, Society of Breast Imaging, American College of Radiology, Susan G. Komen Foundation, and Seattle Cancer Care Alliance.

Furthermore, we particularly disagree with some of the Task Force updates, namely the recommendation against screening women aged 40-49 with yearly mammograms, and to decrease mammography for women over 50 to biannual exams. We feel that although clinical breast examination and breast self-exam may have significant limitations, there is still an important role for these as recommended by the American Cancer Society. We urge you to review the 2 accompanying papers in the Annals of Internal Medicine yourself since those studies have several limitations.

One of the major flaws in the USPSTF analysis is the underestimation of the benefit of mammography, which their meta-analysis of 8 early trials show to be only 15% for women aged 40-49, rather than the 30 or 40% as has been shown in multiple studies. However, even if one takes at face value the reduction of mortality they quote, we believe that those lives are worth saving. The USPSTF estimates that 1904 women in their 40’s would have to be screened to save 1 woman’s life, which they find unacceptable. For women in their 50’s, 1339 women would have to be screened to save 1 life, and they deem this acceptable. We agree with the American Cancer Society’s response that the lifesaving benefits of screening outweigh any potential harm. As a matter of fact, at least 40 percent of years of life saved by mammography screening are for women aged 40-49. Also, if one takes into account the current mortality data from breast cancer, there continues to be a steady decrease in mortality (since 1990) and this benefit is greater in women under 50 (3.2% per year compared to 2% per year for women over 50). The majority of this decrease is from screening and early detection, and it is hard to argue that this is not mostly due to mammography.

Surveys of women show that they are aware of mammography limitations, and also place high value on detecting breast cancer early and the discomfort from the test is not deemed to be a factor. We acknowledge the limitations of mammography, however, the data used in this analysis is not current. Modern digital technology has proven to achieve better results than those early experiments upon which their analysis is based. Digital mammography is what is used here at the Seattle Breast Center.

We are concerned that these new recommendations may falsely reassure patients that they do not need mammograms, when in reality we need to continue to stress the importance of this lifesaving test.
Sincerely,

The Northwest Hospital Committee on Cancer and the Breast Cancer Multidisciplinary Conference

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