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New Breast Cancer Screening Guidelines

Posted Nov 18 2009 12:00am
Wow... the new breast cancer screening guidelines released by the U.S. Preventive Services Task Force are definitely causing a major stir among the healthcare communities and the various breast cancer organizations!  Since these new recommendations regarding routine breast cancer screening for women at normal risk for breast cancer are a substantial move away from the current recommendations and since healthcare policy can be effected by the Task Force's recommendations, it wouldn't be surprising to see the ramifications of these new recommendations discussed for quite some time to come.  Since news stories can sometimes become heated, I wanted to take this opportunity to outline what the recommendations are and the rationale the Task Force used in making them.

U.S. Preventive Services Task Force (USPSTF) Recommendations:
  1. The USPSTF recommends against routine screening mammography in women between the ages of 40-49 years.  The Task Force indicates that there is convincing evidence that mammogram screening in women ages 50-74 years results in a greater reduction of breast cancer mortality than in women 40-49 years of age.  The Task Force futher indicates that there is a moderate certainty that the net benefit of mammogram screening for women 40-49 years of age is small.  Part of the reason for observing only a small net benefit is that false-positives are more common between the ages of 40-49 years, leading to potential harms such as unnecessary biopsies, treatment of cancer that might not become clinically apparent during a woman's lifetime, and psychological stress.  While the Task Force recommends against routine screening for women under 50 years of age, they do suggest that women make individualized and informed decisions regarding when to start mammogram screening.
  2. The USPSTF recommends mammogram screening every two years between the ages of 50-74 years of age.  In their recommendation statement, the Task Force indicates that a large percentage (81%) of the benefits of mammogram screening is retained by screening every other year, while potentially reducing the harms associated with mammogram screening by half. Additionally, the Task Force indicated that the benefits of mammogram screening would likely be reduced if the interval between mammograms was longer than 2 years.
  3. The USPSTF recommends against teaching breast self-examination.  The Task Force reports that there is adequate evidence suggesting that teaching breast self-examination does not reduce breast cancer deaths.  The Task Force's recommendation statement further indicates that there is 'moderate certainty' that harms associated with teaching breast self-examination outweigh the benefits.
In addition to these recommendations, the U.S. Preventive Services Task Force  indicated that there was not enough evidence to assess the benefits and harms of:
  • Clinical breast examinations
  • Digital mammography
  • Magnetic resonance imaging (MRI)
For anyone interested, the full USPSTF Recommendation Statement and the two major papers used to generate these recommendations are freely available to the public.  They can be read online or the full PDF documents can be downloaded.  You can find all these documents HERE.  It would be a good idea for all women, particularly those younger than 50 years of age, to discuss these new recommendations with their physician.

I indicated earlier that these new recommendations are causing quite a stir in the healthcare communities.  One group in particular seems to oppose these recommendations.  The American College of Obstetricians and Gynecologists stands by their current recommendations.  You can read both their RESPONSE to the new USPSTF recommendations and their INTERPRETATION of these recommendations.

 The video below provides a nice overview of the media coverage this story is getting.

In addition to developing a personalized breast cancer screening strategy with your physician, there are many other diet and lifestyle changes that you can make to reduce your breast cancer risk.  Read my book Fight Now: Eat & Live Proactively Against Breast Cancer at to learn more.
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