Dr. Robb-Nicholson's data best supports the scenario that more incidents of breast cancer will be discovered due to the reduced number of screenings that the new guidelines suggest. According to the numbers she gives, the mortality rate for breast cancer decreases every year and this decrease can be attributed to the previous screening guidelines. She writes that the USPSTF has based the new guidelines on statistics rather than clinical data and the message that they are conveying to the public is that the number of deaths that regular screenings at beginning at the age of forty is too small to keep the guidelines as they were previously. (6)
The best approach would be to keep the guidelines the way they were before the change. There was not enough clinical data to support the change in guidelines. Also, because the mortality rate for breast cancer has steadily declined with women following the previous guidelines, there is no rational behind the change. If there are changes to be made to the guidelines, they should be based on clinical data and not just statistics alone. The statistics do not give us a true and clear picture of the mortality rates of breast cancer. And for the USPSTF to state that the number of deaths is too small to stay with the previous guidelines shows a lack of concern for public health issues and in particular, the health of women altogether. They have sent a strong message to the public of what matters and what doesn't matter to them.
The USPSTF needs to carefully review the new guidelines and perhaps wait until there is more clinical data to support it. If there is not enough clinical data to support the change in guidelines, they should remain as they were previously. Even though the incidence of a woman developing breast cancer at the age of fifty is slightly greatly that those in their forties, the fact that the mortality rate for this disease has continued to decrease over past years cannot be ignored. Mammograms and self-examinations are the most useful means of early detection, so it is not reasonable or practical to change anything regarding these processes.
The American Cancer Society (ACS) still displays the former breast screening guidelines on their website. This organization has been in existence since 1946 and can be considered a leading authority on the early detection and prevention of various forms of cancer. The organization provides education on cancer prevention and it works to find a cure for cancer. The website states that the best chances of survival is if the disease if detected early. Regular screenings and self-examinations are listed by the organization as the most important methods of early detection. Of note and interest is that the organization has not changed its guidelines to coincide with those of the USPSTF. (http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp). This should be a red flag since the American Cancer Society has been a leading authority in cancer prevention, early detection and education for over sixty years.
Breast cancer not only affects the person with the disease. It affects all family members. Regular breast screening and self-examinations are an important part of the early detection process. Studies have shown that annual screenings beginning at the age of forty and monthly breast self-exams are very good methods of early detection. The fact that the mortality rate has decreased by at least two percent over the past thirty years is also a good sign that we were on the right path regarding the guidelines. The USPSTF feels otherwise and has made a drastic change in the age in which women should begin regular screenings. There is a ten-year difference in the age of the previous guidelines and the new guidelines. A lot can happen in ten years.
The decision of the USPSTF seems rushed because they made it based solely on statistical data since not enough clinical data was available at the time. They felt that the mortality rate was so small for women between the ages of forty and forty-nine, that the guidelines could be changed. What they are not considering is the health of the underserved populations which are minority women and women from low income households. Women in these categories often do not get the regular screenings that are necessary for early detection of breast cancer. Because of the new guidelines, these women who are usually at a higher risk of getting the disease may be fooled into thinking that they can delay regular screening until the age of fifty instead of forty.
Given all of the potential negative scenarios that could happen based on the new breast cancer screening guidelines, it makes senses for women to take charge of their health and continue to follow the previous guidelines until substantial clinical data can be found to support the new guidelines that the USPSTF has set forth. If women start following the new guidelines, there is a strong possibility that we could begin to see a steady increase per year in the mortality rate. This would take us backwards instead of forward and moving forward is the direction we would like to continue to head in.
1. Cancer Weekly. Concerned Federal Screening Mammography Guidelines to Limit Access for Younger Women. Susan G. Komen for the Cure. 2010: 1665.
2. Earthtimes.org. Stick with Older Mammography Recommendations. Stanford Experts Say. March 3, 2010 (Press Release from Stanford Hospital & Clinics).
3. Hoppel, Ann M. To screen, and when to screen: the mammography age divide. Clinician Reviews. 2009: 19.12.
4. Journal of the American Academy of Physicians Assistants. USP-STF: no routine mammography for women younger than 50 years. 2010; 23.2, p.66.
5. Mandeblatt, Jeanne, Saha, Somnath, et. al. The cost-effectiveness of screening mammography beyond age 65 years: A systematic review for the U.S. preventive services task force. Annals of Internal Medicine. 2003; 139(10): 835-843.
6. Robb-Nicholson, Celeste. A doctors talks about: Screening mammography. Harvard Women's Health Watch. 2010: General Reference Center Gold.
7. Sarff, MaryClare, Schmidt, Katherine and Vetto, John T. Targeted breast cancer screening in women younger than 40: results from a statewide program. 2008; 195(5): 626-630.
8. Saywell, Jr., Robert M. Champion, Victoria L., Sugg-Skinner, Celette and Joanne Daggy. A cost-effectiveness comparison of three tailored interventions to increase mammography screening. Journal of Women's Health. 2004; 13(8): 909-918.
9. Sutton, Sharyn M., Eisner, Ellen J., Bloom, Diane L., and Bloom, Paul N. The Mammography Guidelines Controversy: What Do Women Think? Advances in Consumer Research. 1994; 13: 387-391.