Breast Cancer Screening Guidelines

mammogram_womanReduced Need for Mammography

Unless you've been living under a slimy rock this week, you know that the US Preventive Services Task Force has changed the screening guidelines for breast cancer. Instead of annual mammograms for all women over the age of 40, the guidelines are now tailored to reflect when the risk for developing breast cancer increases, and that's largely after menopause. Incidentally, right when the risk for the real killer in the room, heart disease, also rises. Here's the link to the recommendations, published in Annals of Internal Medicine: Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement.

The buzz over this change has been astonishing. The most pejorative comments seem to be coming from women concerned about a reduction in services at a moment when the nation is closely examining the spectrum of healthcare costs and seeking ways to reduce them. The outcry is fraught with allegations that women are once again being relegated to second class citizenry, with improvement in the nation's healthcare budget coming at the price of breast health. Really. Here's a novel idea: let's examine the data.

The data analysis shows that the number of screening mammograms needed to extend one woman's life relative to breast cancer in those aged 40 to 49 is 1904. That's a lot of screening, and as we're now seeing that radiation itself related to mammography may be harmful since its effects are cumulative, that's also a lot of potential damage. Add to that the psychological impact of being told you have a lump in your breast, the need for biopsy and perhaps lumpectomy, and the risk/benefit ratio tips clearly in the direction of reduced screening.

What about breast self-examination? The task force also found that there's insufficient evidence to support continued endorsement of this practice. But clearly, women are free to examine their breasts and report suspicious findings to their healthcare provider. No harm there.

Finally, the furor has been so overwhelming that for now, federal agencies that pay for routine annual mammography have stated that they will continue to do so. Since private insurers largely follow their lead, women who feel strongly about continued annual mammography are free to do so.

Interestingly, another issue critical to women's health we didn't talk about this week in the podcast is the change in recommendations for cervical cancer screening. Once again, data driven and based on research related to risks and benefits. And just to give fair play to the guys, the PSA/prostate cancer controversy also rages on, with Rick having stated that he hasn't had PSA screening and doesn't intend to anytime in the near future.

Other topics this week include whether more of a statin or the supplement niacin is best to reduce cholesterol from the American Heart Association meeting, published online in NEJM, dangers of drugs to stimulate red blood cell production in NEJM, and the relationship between cancer and vitamin B12 and folate supplements in JAMA. Until next week, y'all live well.

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Comments

Vanessa Elizebeth March 12, 2013 at 5:23 am

Screening is looking for cancer before a person has any symptoms . This can help find cancer at an early stage .When abnormal tissue or cancer is found early,it may be easier to treat .By the time symptoms appear ,cancer may have begun to spread.

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Jaylen September 4, 2011 at 4:46 am

Four score and seven minutes ago, I read a sweet article. Lol takhns

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Chicago liposuction February 26, 2010 at 12:41 am

I like the post which includes the proper examine of the issues and links govern the case of deadly breast cancer.There is self examined of this type of cancer which should be regulated through over.Women's can take note of that and concern the issues to the doctor if the matter is being worsened.I agree on the stand that The task force also found that there's insufficient evidence to support continued endorsement of this practice. But clearly, women are free to examine their breasts and report suspicious findings to their healthcare provider.

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