Recently, the U.S.Preventive Services Task Force made recommendations regarding the screening process for breast cancer which has ignited an emotionally charged firestorm. This was detailed in an article published in The NY Times. Previous recommendations were that women of average risk should begin routine screening mammograms on a yearly basis at the age of 40. However, after reviewing the data, the new guidelines advise that women should not get routine screening mammograms until the age of 50 and the women between the ages of 50 to 74 should only have them performed every 2 years. In addition, the Task Force discourages doctors from advising women to examine their own breasts regularly. It is these two recommendations that are the basis for the discussion.
As physicians, we make every attempt to practice medicine in an evidence-based fashion. In other words, we have to look at the data and decide what the appropriate course of action or inaction is for a particular patient. We also know that there are significant risks associated with every procedure that is performed and that screening tests are not perfect. If a patient is mistakenly diagnosed with possible breast cancer, then the patient will be subjected to further testing and procedures that they may not need. Specifically, the Task Force noted the risks associated with unnecessary surgery, radiation exposure, and psychological harm.
However, as a physician who cares for breast cancer patients through breast reconstruction, I am concerned about the possible implications of such a recommendation. Stating that doctors should discourage their patients from examining their own breasts on a regular basis seems absurd. I have seen numerous patients in their 30's and 40's with a new diagnosis of breast cancer that was identified by self examination or by mammography. I understand that the percentage of breast cancer patients in this age range is relatively low. However, if you are the patient with breast cancer, you feel like your risk was 100%. Catching breast cancer early may mean a woman may not need as aggressive a therapy. If we have a modality that can pick up the disease early, why should we keep if from women?
This debate is an important one particularly in light of the pending changes to healthcare in the U.S. Reducing the number of recommended mammograms may improve the overall bottom line, slightly. However, it will definitely increase the pain and suffering of the women diagnosed with breast cancer at a later stage when it could have been detected earlier. Though the data still needs to be reviewed further, it is understandable why numerous organizations such as the American Cancer Society and the American Congress of Obstetricians and Gynecologists (ACOG) still recommend annual screening mammograms beginning at age 40 despite this recent report. At this point, we can only hope that insurance companies do not follow the new recommendations resulting in lower benefits and coverage for every woman.
