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Journal Commentaries Discuss Mammogram Recommendations

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In November 2009, the U.S. Preventive Services Task Force recommended controversial changes to breast cancer screening guidelines. Four commentaries in the Journal of the American Medical Association offer various perspectives on some of the recommended changes.

The task force recommended that routine screening mammograms for women with an average risk of beast cancer should start at age 50, instead of age 40. One commentary said the word "routine" is important to understanding this recommended change. According to Dr. Steven Woolf, the task force supported screening mammograms for women younger than 50 -- just not routine mammograms for all women younger than 50. The task force recommended that screening mammograms for women between age 40 and 50 be done selectively, after a woman and her doctor carefully consider all the benefits and risks of screening. Risks include false positive results (an abnormal area that looks like cancer but turns out to be normal), as well as biopsies (and other tests) and worry that go along with false positives. believes that all medical decisions, including if and when to screen for breast cancer, are individual decisions to be made by each woman in consultation with her doctor. Still, disagrees with the recommended change, since it may discourage women from getting mammograms and could possibly allow insurance companies to deny coverage for mammograms done before age 50.

The task force also recommended that breast self-exam shouldn't be taught or encouraged. This recommendation was based on evidence that breast self-exam leads to an unacceptably high level of false positive scares and unnecessary biopsies. Some advocacy organizations (the American Cancer Society is one) also no longer support teaching and promoting breast self-exam. Still, a second commentary notes that many women are diagnosed with breast cancer because of something they felt during a breast self-exam. believes breast self-exam can be a valuable part of any woman's overall personal breast health monitoring and screening plan. Unlike screening mammograms, the "cost" of breast self-exam is only your time and commitment.

Finally, the task force recommended that screening mammograms in women older than 75 shouldn't be encouraged. This recommendation was made because there's no evidence of an overall public health benefit to screening women older than 75. Still, women in their 80s can expect to live until nearly 99 -- so diagnosing breast cancer with a screening mammogram makes sense if a woman older than 75 is in reasonably good health and would want to be treated for breast cancer should she be diagnosed. believes that the importance of diagnosing breast cancer early, when it's most treatable, doesn't diminish as a woman gets older. Regular screening makes sense for older women in reasonably good health and who would want to be treated for breast cancer if they were diagnosed.

Like many in the community, you may have questions about the debate triggered by the task force recommendations. offers information about the recommendations, including how they came about, how they might influence screening in the future, and what they mean for women today.

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