New Government Mammography guidelines spark debate

This week, an influential government panel known as the U.S. Preventive Services Task Force (USPSTF), whose recommendations influences coverage of screening tests by Medicare and many insurance companies, has come out with new guidelines for mammography, particularly when testing should start, and how often it should be performed. Their article is published in the latest issue of Annals of Internal Medicine (link to article).

These new USPSTF guidelines are sure to spark a hot debate, as the panel claims that:

1) women don't really get a "significant" benefit from mammography until after age 50, rather than age 40, which is the current standard.

2) the mammograms are only needed every second year, not every year, thereafter, which is a change from the current standard.

The American Cancer Society (ACS) and National Cancer Institute (NCI) have already issued statements saying that they don't agree with these looser recommendations, pointing out that breast cancer is a significant issue for women in their forties, and that screening with mammography saves lives - about 1 life saved for every 1900 people screened in the 40-50 age range. (Click here for detailed ACS analysis.) The ACS and NCI fear that, with less screening, that the benefits of early diagnosis and treatment will be lost. The USPSTF panel, on the other hand, feels that the benefit of putting most women through mammograms in their 40's is small, and doesn't outweigh the extra biopsies and drawbacks of additional radiation.

I also wonder if Medicare and insurance companies will use the new USPSTF report as an excuse to reduce the coverage of mammography. Patients may tend to "slack off", and put off getting a mammogram.

I'll be reviewing the original article in detail on my own - but for now, I will continue to follow the ACS and NCI current standards, and recommend that women start mammography at age 40, unless they are in the "high risk" group, in which case it should start even earlier, not later.