In November 2009, the U.S. Preventive Services Task Force (USPSTF) recommended changes to breast cancer screening guidelines:
- routine screening mammograms for women with an average risk of beast cancer should start at age 50, instead of age 40
- women older than 75 shouldn't be encouraged to get screening mammograms
- breast self-exam shouldn't be taught or encouraged
Experts have offered their opinions on the recommendations.
Age to start routine screening mammograms
Some experts said the word "routine" was key to understanding the intentions of the recommendation. Task force members have said they didn't mean screening mammograms for women younger than 50 were inappropriate. Instead, their recommendation was that a younger woman get a screening mammogram only after the 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.
Looking back, some experts feel that the USPSTF had good intentions, but could have written the recommendations more clearly. Some experts believe that most women between age 40 and 50 who have all the information about screening mammograms' benefits and risks will choose to be screened; so "routine" screening makes sense. Other experts believe that the biggest risk of screening between age 40 and 50, which wasn't discussed in the USPSTF analysis, is over-diagnosing and unnecessarily treating abnormal areas that wouldn't have become a health threat.
Breastcancer.org believes that all medical decisions, including if and when to screen for breast cancer, are decisions to be made by each woman and her doctor. Breastcancer.org is still concerned about the USPSTF recommendations, since saying that women age 40 to 50 don't need "routine" screening mammograms could discourage women in that age group from getting mammograms. The recommendation also could have meant that insurance companies might not cover mammograms done before age 50. Fortunately, the U.S. Congress passed legislation so that will not happen.
Mammogram screening in women older than 75
The USPSTF recommended against screening mammograms for women older than 75 because it found no evidence of an overall public health benefit from routine screening for these women. Nearly all experts would agree that screening doesn't make sense in an older woman who wouldn't want to be treated for breast cancer because of personal preferences or other health matters. Still, many women age 80 or older can expect to live another 10 years or more; many are in reasonably good health and would want to be treated.
Breastcancer.org believes that the importance of diagnosing breast cancer early, when it's most treatable, doesn't get any less important as a woman gets older. Regular screening mammograms make sense for older women who are in reasonably good health and who would want to be treated for breast cancer if diagnosed.
The USPSTF recommendation against teaching and encouraging breast self-exam was based on evidence that breast self-exam leads to a high level of false-positives and unnecessary biopsies. Some advocacy organizations (the American Cancer Society is one) agree with that analysis and no longer support teaching and promoting breast self-exam. Still, all experts agree that many women continue to be diagnosed with breast cancer because of something they felt during a breast self-exam.
Breastcancer.org believes breast self-exam can be a valuable part of any woman's personal breast health monitoring and screening plan. Unlike screening mammograms, the cost of breast self-exam is only a woman's time and commitment.
For more information on mammograms and other tests to detect breast cancer, visit the Breastcancer.org Screening and Testing section.
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