These recommendations for change in the guidelines for screening mammography, clinical breast examination and breast self-examination are in conflict with the facts. Careful review of the considerable literature from numerous clinical trials in the United States and elsewhere confirms that screening mammography reduces mortality from breast cancer as well as the morbidity associated with a breast cancer diagnosis. With screening mammography, the death rate from breast cancer has decreased by more than 30 percent since 1990. (The most recent of the clinical trials show a reduction in the death rate of greater than 40 percent, and specifically confirms this benefit for women aged 40-49.) The reduction in the death rate is apparent in all women screened, including women in their 40s as well as older women.
In addition to the dramatic decline in the death rate from breast cancer, less aggressive treatment may be needed for those women with an early diagnosis of breast cancer.
The recommendations from the task force, if followed, could reverse this hard-won reduction in breast cancer morbidity and mortality, placing large numbers of women at risk for early death from breast cancer.
The task force acknowledges that mammography beginning at age 40 saves lives, just not enough of them. Screening 1,339 women between the ages of 50-59 with mammography saves one life, and the task force finds that reasonable. For women ages 40-49, 1904 screening mammograms are needed for each life saved, and the Task Force states that is not worthwhile. The incidence of breast cancer for women between the ages of 40 and 49 is one in sixty-nine.
The task force focused on the potential "harms" of mammography (including discomfort of the exam, anxiety over positive results and possible over-treatment), stating that these outweigh the greatly decreased number of deaths each year resulting from breast cancer screening. While mammography is not a perfect tool, there are continuing improvements in the technology that add to the accuracy of the test. The benefit of screening mammography far outweighs the limitations.
The American Cancer Society, The American Society of Breast Disease, The Susan Komen Foundation, The American College of Obstetricians and Gynecologists, The Society of Breast Imaging, The American College of Radiology and the National Cancer Institute, among others, disagree with The U.S. Preventive Services Task Force recommendations. Each of these groups has issued formal statements urging women to continue with the current guidelines.
Alaskans are diagnosed with breast cancer every day, many following a routine screening mammogram. Do yourself a favor and continue to follow the current guidelines:
• Annual clinical breast examination from your health care provider
• Annual screening mammogram, beginning at age 40
• Breast self-examination has the potential to detect palpable breast cancer and should be considered.
Denise Farleigh, M.D., is medical director and director of breast imaging at Providence Imaging Center.
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