To recap, here are the new guidelines (which do not apply to higher-risk women):
- Women between the ages of 40 and 49 should not be routinely screened.
- Women between the ages of 50 and 74 should be screened every two years.
- Screenings are unnecessary for women 75 and older.
- Women should not be taught how to perform breast self-examinations.
- There is no additional benefit to clinical breast examination by doctors, nor are there added benefits to digital mammography or magnetic resonance imaging over film mammography.
And here are the old guidelines, from a study only seven years old which relied mostly on the same data:
- Women should start getting annual mammograms at age 40.
- Doctors should perform clinical breast examinations and teach breast self-examinations.
What is the panel's reasoning? While screenings definitely reduce breast cancer mortality, they can also result in psychological harm, unnecessary tests and biopsies due to overdiagnosis and false-positive results. In contrast to a false positive, (the detection of a possible cancer which turns out not to be one) overdiagnosis is the detection of a cancer that would never have become clinically apparent, and is often followed by unnecessary overtreatment, which can be harmful to the patient.
False-positive results were more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups. Therefore, the benefit of screening for women 40 to 49 years was found to be small. For the 50 to 74 group, the biennial screening maintains almost all of the benefit of annual screening (81%) with almost half the number of false positives.
You Won't Find Cancer If You Don't Look For it
But here is the "old" reasoning, and it's quite simple: Screening with mammography reduces breast cancer mortality in women ages 40 to 74. The American Cancer Society adds that the limitations of the screening (such as false-positives) do not change that fact. The ACS is maintaining its recommendation of yearly mammograms for women beginning at age 40.
The ACS is not alone in pushing back against the new guidelines. Some doctors said they would ignore them and continue to advise patients to have mammograms early and often, according to The New York Times. While there are pros and cons to mammograms, says Dr. Marisa Weiss, the founder of Breastcancer.org, women who don't get one have no chance for a mammogram to do what it's meant to do – spot problems. Experts also question the study's methodology, saying the researchers didn't take into consideration all the factors they should have. For example, one-sixth of all breast cancer deaths arise in women diagnosed in their 40s.
However, many women are no doubt ecstatic about these new recommendations, and would opt for fewer exams. While many cancer advocates say it's this reaction they fear, others say the new recommendation makes sense. Women in their 40s tend to have denser breasts, which make mammograms less reliable in finding lumps, Stephen Ethier, associate director of basic research at Karmanos Cancer Center in Detroit, told the Detroit Free Press.
The self-examination guideline also drew criticism, with proponents claiming women should know their breasts and any changes to them. Just in February, a study found that two-thirds of breast cancers in Hispanic women are detected by self-exam, despite high screening tests.
At the end of the day, just as the study researchers say, it all depends on the woman and her doctor. The panel doesn't say to not get a mammogram; it gives guidelines to healthy women. But the decision to start regular screening before the age of 50, they say, should be an individual one.
Breast cancer is the second-leading cause of death among U.S. women, after lung cancer, killing 40,480 women in 2008.
Update: On Nov. 18, HHS Secretary Kathleen Sebelius found it necessary to issue a formal statement to address the criticism. The policies remain unchanged, she says, telling women to "Keep doing what you have been doing for years."
