Any women who survived breast cancer will tell the same story: they survived because their cancer has been detected in time, due to the annual mammogram. But, it seems that the doctors, or at least doctors employed by the government, do not agree that annual breast screening is so important, so they decided to change the rules radically. Now, before you are 50 and after you are 74, you should not get screened at all. Unless you insist and are able to pay for it.
What has changed?
In 2011, The Department of Health and Human Services formed a group of independent health professionals into the U.S. Preventive Services Task Force (USPSTF), to provide new recommendations about the benefits of breast screening and to offer new guidelines. According to the new guidelines, there is no sufficient evidence to continue annual breast cancer screening before the age of 50 and after the age of 74. Here is the summary of the Task Force”s recommendations:
- Regular screening of women should start at age 50, not 40
- Regular screening should not be done for women over the age 74.
- Regular screening now means every two years, instead of annually, as before
- Self-examination of breasts is not recommended, whether it is done by a doctor or by women themselves, as it has no value
According to the guidelines, women in the high risk group, such as those who have breast cancer in the family, or those who have the breast cancer genes BRCA1 or BRCA2, should continue with annual mammograms.
Why the changes?
The Task Force defends their recommendation by the results of two studies they have commissioned, and by the insufficient evidence that earlier, as well as annual, screening has sufficient benefits.
Medical community is divided over the recommendations. Some believe that mammogram, which often produces false positive results, often results in unnecessary biopsies and anxiety. They also believe that many women with slow growing breast cancer should not have undergone therapy or mastectomy, as the cancer would not have affected their longevity. Others, including American Cancer Society, do not agree with the recommendations and continue to advise women to do regular annual mammogram. Many believe that the decision is mostly about cost cutting.
One of the many paradoxes of the new recommendations is that the self-examination has no benefits, on one hand, and that many breast cancers would have been detected without the regular mammogram. How? Another paradox is that the breast cancer is the disease of the old age, hence no screening under the age of 50, on one hand, and on the other hand that women over 74 should not be screened. With our increased longevity, that puts so many healthy women over 74 to unethical risk.
There is a fair chance that Medicare and many private insurance companies will decide to stop covering annual mammograms, based on these recommendations. That means that women who still want to be screened before they are 50 or are over 74, will have to pay for it themselves. Others will have to take their chances.
The number of women diagnosed with breast cancer has been declining in the last 30 years. We can only hope that the new recommendations will not change that.