New Breast Cancer Screening Guidelines

New breast cancer screening guidelines is an important topic because it affects all women. Not only does it affect women, it affects their children and other family members and friends. Breast cancer is a serious disease and the new guidelines appear to have taken us a step backwards instead of moving us forward in our efforts to continue to decrease the mortality rate. The new guidelines suggest that women get their first breast exam at the age of fifty instead of forty. Specifically, the new breast screening guidelines established by the United States Preventative Services Task Force (USPSTF) determined in November of 2009 that routine screening should begin at the age of fifty instead of forty and that clinical as well as self breast exams are scaled back. The established guideline of a screening every other year for women in their fifties and sixties has not changed.(6)

If healthcare providers adhere to these new guidelines, many women in their forties and younger are being placed at risk since early detection is no longer an option. Breast cancer screening is an effective way of early detection and in most cases this screening can detect the early stages of cancer even before the patient discovers that small lump while performing a breast self-exam. Breast cancer is one of the leading causes of death in women and previous guidelines must be taken seriously. The Susan G. Komen for the Cure organization does not agree with the new guidelines and feel that the age for the start of breast cancer screening should remain at forty.(1) The USPSTF has also stated that women as well as their physicians should cut back on performing breast self-examinations. This does not appear to be a good idea and seems to be steering women away from taking charge of their own health. A physician would only perform this examination approximately once a year at the time of the patient's annual exam, but in the past, women have been encouraged to perform breast self-examinations at least once a month. These once a month self-examinations could play an extremely large and important role in early detection. Many women (young and older) have discovered small lumps in their breast long before they were due for a mammogram.

It does not make sense to scale back on every aspect of the guidelines. If women are being encouraged to begin with regular mammograms at the age of fifty, they most certainly should not be discouraged from performing self-examinations. If all viable options regarding this issue are being discouraged, this leaves women open to threat of getting breast cancer and not finding out about it until it is too late. The mortality rate would increase for sure and then the USPSTF will need to go back to recommending the previous guidelines.

This topic was chosen because of the potential negative impact it can have on early detection and survival rates from the disease. Breast cancer can happen in men, but it is rare. The majority of victims of this disease are women as therefore, women must come together collectively and challenge the new guidelines. Our voices must be heard so we can move toward forcing the USPSTF to establish guidelines that benefit us and not work against us. Also, everyone needs to be concerned about how these new guidelines will affect them. Most everyone has had a mother, sister, aunt, cousin or other relative that is either a breast cancer survivor or a loved one that has succumbed to the disease.

History

Regular breast cancer screening began in 1990 and since then the morality rate has declined thirty percent.(1) This steady decline in mortality is proof positive that we were headed in the right direction with the previous guidelines for screening. Back in the early 1990's, many efforts were made to instill in women the importance of regular mammograms. At this stage, women still feared excessive exposure to radiation from mammograms as well as the possibility of an inaccurate reading. When it comes to preventative health, those in the medical professions should always consider consumers and their views on the subject. Whether or not consumers trust the decisions of health care providers and how they process scientific data play a large role in the choices they make regarding their health.(9)

According to Dr. Robb-Nicholson, 192,370 cases of breast cancer occurred in 2009 and of this number, 40,170 women died from the disease. She states that since 1990, there has been a steady decline in the mortality rate of two percent per year. (6) The USPSTF decided to update the breast cancer screening guidelines based on a meta analysis and decision analysis. The analysis showed that the risk of breast cancer was greater in women over fifty years of age than those younger than this. They also determined that a very small number of women younger than forty benefit from regular breast cancer screening. (3,4) Because of these determinations, the new guidelines were established.

Analysis

Many physicians and healthcare professionals recommend that women follow the previous screening guidelines. They also encourage women to continue with breast self-exams even though evidence shows that these self-exams do not increase breast cancer detection. (2) Given this, it is still imperative that women make informed decisions regarding their health for themselves. Because of the steady decrease in mortality in those who get regular screenings over the years, the guidelines should not have changed.

The USPSTF seem to base their decision to change the guidelines on statistics that aren't large enough to justify these changes. This organization has not taken into account the statistics from other organizations aimed at preventing, or at the very least, decreasing the mortality rate of women with the disease. Their decision for the change could be based on several factors. One of them is the cost effectiveness of annual screenings. With the many issues this country is facing with healthcare, some procedures may be seen as less important than others. If this is the case, even the slightest and most minute bit of evidence showing a trend towards the possible need to decrease annual screenings may have been a factor in the USPSTF to make a hurried decision which will no doubt affect thousands of women. However, it remains a fact that breast cancer is the second leading cause of avoidable death among women.(5)

The new breast cancer guidelines affect the healthcare discipline in several ways. One way is that it will force patients to become more aware and thus take control of their health as opposed to relying on a healthcare professional to instruct them on the issue. If patients have a family history of breast cancer, they must take it upon themselves to get regular screenings and perform monthly self-examinations and not rely on the current guidelines. Patients must take charge and be in control of their own health.

Another way that this issue affects the healthcare discipline is that there is a possibility that there may be an increase in the rate of breast cancer among women, especially with women who normally have to be prodded into getting regular exams. Young women, (those under forty years of age), may be lulled into a false sense of security based on the new guidelines and feel that they won't need a mammogram until they reach the age of fifty. Statistics have shown that by the age of forty, one in 217 women will develop breast cancer. Studies have also shown that African-American women and women from low-income households are less likely to get mammograms as are women of other races. Women in this category normally may have at least one mammogram, but many need to be reminded and encouraged by their healthcare professional to continue with regular screenings. (7, 8) These new guidelines do very little to reinforce the fact that annual breast screening is important.

Future

A major scenario that could possibly unfold is that health insurance companies may adhere to the new guidelines and instead of covering the cost of one mammogram per year beginning at age forty, they may decide that they will only pay for one mammogram per year beginning at the age of fifty. This will pose major health implications for women who are susceptible to the disease. If this scenario were to play out, women will need to find an alternative way of affording the screening that they need during the year that the insurance company does not pay for.

Another scenario is that monies could be drastically reduced for programs that are federally funded to help low income women obtain the health services they need such as regular breast screening. This could cause major issues across economic lines because if funding is cut, women from low income families may not receive the necessary screening. Saywell, et.al did a study on cost-effective methods to get the word out to women of color and those from low-income households on the importance of getting regular screenings. (8) If funding is cut across the board, this will be the largest group that will be forgotten and left out in the cold.

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.

Conclusion

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.