[Joan M]

Unfortunately, the new guidelines for reducing the number of mammograms performed for women ages 40-49 have found an ear in the age of medical/Medicare reform and cost cutting.

Here's a news story about the new guidelines.

16 Nov 2009

New U.S. guidelines: routine mammograms start at 5o

By Julie Steenhuysen

CHICAGO (Reuters) - Sweeping new U.S. breast cancer guidelines released on Monday recommend against routine mammograms for women in their 40s, but several groups immediately rebelled against the recommendations.
The new guidelines by the U.S. Preventive Services Task Force, an influential panel of independent experts, would sharply curtail the number of breast mammograms done in the United States, sparing women the worry of false alarms and the cost and trouble of extra tests.

U.S. cancer experts argued the altered schedule may mean more women will die from breast cancer.

The guidelines, published in the Annals of Internal Medicine, are based largely on computer projections from six independent research groups in the United States and Europe.

They predicted that screening women 50 to 69 every other year will catch nearly as many breast cancers -- 81 percent -- while producing half as many false positive results.

"Although the USPSTF recognizes that the benefit of screening seems equivalent for women aged 40 to 49 years and 50 to 59 years, the incidence of breast cancer and the consequences differ," the task force, sponsored by the U.S. Agency for Healthcare Research and Quality, wrote.

The group's last recommendations in 2002 called for routine mammograms every one to two years for all women older than 40.

Now, they recommend no routine screening for women in their 40s, and instead suggest these women decide for themselves when to start after weighing the risks and benefits.

"This is not a recommendation against mammography for women in their 40s," said Dr. Diana Petitti, professor of biomedical informatics at Arizona State University in Phoenix, who spoke on behalf of the task force.

LETTING CANCER LIE
The panel said there is not enough evidence to say women over 74 benefit from mammograms because at that age, screening may be detecting cancers that will not ever kill a woman.

The guidelines also say there is not enough evidence to prove that women benefit from breast self-examinations, or even if they help if doctors do them.

Dr. Daniel Kopans, professor of radiology at Harvard Medical School in Massachusetts, said the new guidelines "are scientifically unjustified and will condemn women ages 40 to 49 to unnecessary deaths from breast cancer."

"If you look at their guidelines, they are saying, 'Don't examine yourself, don't let anyone else examine you, and don't get a mammogram.' Where does that leave you? It leaves you waiting to have a big cancer that you can't ignore any more," Kopans said in a telephone interview.

The American Cancer Society and the American College of Obstetricians and Gynecologists said they will not be changing their guidelines.

"The American Cancer Society will continue to recommend that women of average risk of breast cancer start screening at age 40 and get screened every year," Dr. Len Lichtenfeld, the group's deputy chief medical officer, said in a telephone interview.

Dr. Carol Lee, chair of the American College of Radiology Breast Imaging Commission, said the recommendations "ignore the valid scientific data and place a great many women at risk of dying unnecessarily."

Lee and Lichtenfeld said they fear insurers -- both private and public -- will use them to pare back health costs.

"These new recommendations seem to reflect a conscious decision to ration care," Lee said, although Petitti said cost was not a factor in their decision-making.

The National Cancer Institute, which funded the modeling study, said women of average risk need to discuss the risks and benefits of mammograms with their doctors.

"NCI has had screening mammography recommendations for many years, and we need to evaluate them in light of the Task Force's recommendations -- for all women, not only for those of average risk. It's too early for us to make any decisions right now," the federal agency said in a statement.

Breast cancer is the top cancer killer of women globally, killing 500,000 annually.

Joan