Startling new mammogram guidelines incite debate about risk, cost

Nov 17 2009

The Washington Post: "Women in their 40s should stop routinely having annual mammograms and older women should cut back to one scheduled exam every other year, an influential federal task force has concluded, challenging the use of one of the most common medical tests" (Stein, 11/17).

The New York Times reports: "The new recommendations, which do not apply to a small group of women with unusual risk factors for breast cancer, reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. ...  Just seven years ago, the same group, the United States Preventive Services Task Force, with different members, recommended that women have mammograms every one to two years starting at age 40. ... The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services."

The new guidelines, published online in The Annals of Internal Medicine, are aimed at preventing possible harm from overtreatment. "While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman's lifetime, resulting in unnecessary treatment" (Kolata, 11/16).

The Wall Street Journal reports: "...the new guidelines are likely to be controversial and confusing. They also raise concerns that health insurers will curtail coverage and reimbursements for screenings that fall outside the guidelines, according to doctors and groups including the American Cancer Society."

"About $3.3 billion was spent on mammograms in the last 12 months, according to the American College of Radiology. ... Whether the new guidelines lead to changes in insurance reimbursement is likely to be a big concern among health providers and patients. The Centers for Medicare and Medicaid Services, which administers government health benefits for the elderly and the poor, says the new guidelines wouldn't change how it covers mammograms for Medicare patients. But that may not be the case for private insurance" (Wang, 11/17).

NPR notes: "Women in the United States are being diagnosed with breast cancer earlier than their mothers were, as well as women in certain minority groups, says American College of Radiology chairwoman Dr. Constance Lehman. 'Black women in the U.S. develop breast cancer at a significantly younger age than Caucasian women do.' This was not addressed or acknowledged by the task force, she says" (Wilson, 11/16). 

The Los Angeles Times reports: "Oncologists were nearly uniform in their disparagement of the guidelines, fearing the loss of a valuable cancer-prevention tool. Women in their 40s account for at least a quarter of breast cancer diagnoses. ... And other groups that issue guidelines about screening and prevention, such as the American Cancer Society, the National Cancer Institute and the American College of Obstetricians and Gynecologists, immediately attacked the federal panel's conclusion, saying that they would not change their guidelines and would continue to urge women to undergo the tests" (Graham and Maugh, 11/17).

CBS/The Associated Press: "International guidelines also call for screening to start at age 50; the World Health Organization recommends the test every two years, Britain says every three years. Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year. Mammograms can find cancer early, and two-thirds of women over 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated" (11/16).

CNN: "The task force is composed of 16 health care experts, none of whom are oncologists. The group reviews medical data and bases recommendations on effectiveness and risks involved. 'All we are saying is, at age 40, a woman should make an appointment with her doctor and have a conversation about the benefits and harms of having a mammography now versus waiting to age 50,' said Dr. Diana Petitti, vice chair of the task force" (Dellorto, 11/16).