USPSTF Breast Cancer Screening Guidelines: A Critical Review

Introduction

New breast cancer screening guidelines represent an important topic because they affect all women. Not only do they affect women directly, but they also affect their children, other family members, and friends. Breast cancer is a serious disease, and the new guidelines appear to have taken us a step backwards rather than forward in our efforts to continue decreasing the mortality rate. The new guidelines suggest that women receive their first breast exam at the age of fifty instead of forty. Specifically, the new breast screening guidelines established by the United States Preventive 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 should be scaled back. The established guideline of a screening every other year for women in their fifties and sixties remained unchanged. (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 encouraged as it once was. Breast cancer screening is an effective means of early detection, and in most cases this screening can detect the early stages of cancer even before the patient discovers a small lump while performing a breast self-exam. Breast cancer is one of the leading causes of death in women, and the previous guidelines must be taken seriously. The Susan G. Komen for the Cure organization does not agree with the new guidelines and maintains 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 reduce the frequency of breast self-examinations. This does not appear to be a sound recommendation and seems to steer women away from taking charge of their own health. A physician would 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 monthly self-examinations could play an extremely important role in early detection. Many women — young and older alike — 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 regular mammograms at the age of fifty, they most certainly should not be discouraged from performing self-examinations. If all viable detection options are being discouraged simultaneously, this leaves women exposed to the threat of developing breast cancer without discovering it until it is too late. The mortality rate would almost certainly increase, and the USPSTF would then need to revert to recommending the previous guidelines.

This topic warrants attention because of the potential negative impact it can have on early detection and survival rates. Breast cancer can occur in men, but it is rare. The majority of those affected by this disease are women, and therefore women must come together collectively and challenge the new guidelines. Everyone needs to be concerned about how these new guidelines will affect them. Most people have had a mother, sister, aunt, cousin, or other relative who is either a breast cancer survivor or a loved one who has succumbed to the disease.

History of Breast Cancer Screening

Regular breast cancer screening began in 1990, and since then the mortality rate has declined by thirty percent. (1) This steady decline in mortality is clear evidence that the previous guidelines were moving us in the right direction. In the early 1990s, many efforts were made to instill in women the importance of regular mammograms. At that stage, women still feared excessive exposure to radiation from mammograms as well as the possibility of inaccurate readings. When it comes to preventive health, those in the medical professions should always consider consumers and their perspectives on the subject. Whether or not consumers trust the decisions of healthcare 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 that number, 40,170 women died from the disease. She notes 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 in those younger than fifty. The task force also determined that a very small number of women younger than forty benefit from regular breast cancer screening. (3, 4) Based on these determinations, the new guidelines were established.

Analysis of the New Guidelines

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 some evidence suggests that these self-exams do not independently increase breast cancer detection rates. (2) Given this, it remains imperative that women make informed decisions regarding their own health. Because of the steady decrease in mortality among those who received regular screenings over the years, the guidelines should not have been changed.

The USPSTF appears to have based its decision to change the guidelines on statistics that are not substantial enough to justify these changes. This organization has not adequately taken into account the data 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 which is the cost-effectiveness of annual screenings. With the many challenges this country faces in healthcare, some procedures may be viewed as less critical than others. If this is the case, even the slightest evidence suggesting a possible trend toward reduced annual screenings may have prompted the USPSTF to make a hurried decision that will no doubt affect thousands of women. Nevertheless, it remains a fact that breast cancer is the second leading cause of avoidable death among women. (5)

The American Cancer Society (ACS) continued to display the former breast screening guidelines on its website following the USPSTF announcement. 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. It provides education on cancer prevention and works to find a cure. The ACS website states that the best chances of survival depend on detecting the disease early, and it lists regular screenings and self-examinations as the most important methods of early detection. Of particular note is that the organization did not change its guidelines to coincide with those of the USPSTF. This should be considered a significant warning sign, given that 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 effective methods of early detection. The fact that the mortality rate has decreased by at least two percent annually over the past thirty years is a strong indication that the previous guidelines were working. The USPSTF has disagreed and made a significant change in the recommended age at which women should begin regular screenings. There is a ten-year gap between the previous guidelines and the new ones, and a great deal can happen in ten years.