USPSTF-recommended guidelines lead to decline in mammograms and early detection programs for women under 50

Avon Foundation for Women Survey Examines Early Impact of New Breast Cancer Screening Guidelines

In some states women ages 40 to 49 have less access to mammograms since the U.S. Preventive Services Task Force (USPSTF) released its recommendations to change breast cancer screening guidelines last November, according to a recent survey conducted by the Avon Foundation for Women. The USPSTF recommended changing the current mammography screening guidelines for average risk women to begin biennial screening at age 50 instead of annual mammograms starting at age 40.

At its annual Avon Foundation Breast Cancer Forum, the Avon Foundation for Women released data from an online survey of more than 150 breast cancer health educators and providers from 48 states and the District of Columbia, all of which are Avon Foundation grant recipients.

The purpose of the survey was to determine what, if any, affect the new USPSTF-recommended guidelines may be having on the number of women under age 50 accessing mammograms and other early detection programs. These organizations are attending the Forum and range from small community groups like the YWCA North Rhode Island to leading cancer centers like Johns Hopkins University.

"Our survey gives us an early indication from those working on the front lines of breast cancer education, screening and treatment as to how the recommended guidelines may be affecting their work," said Marc Hurlbert, director of the Avon Foundation Breast Cancer Crusade.

Respondents from 25 percent of the states represented in the nationwide survey report changes in their states' Breast & Cervical Cancer Early Detection programs. According to these respondents, the USPSTF-recommended guidelines combined with other factors, such as budget cuts, have resulted in fewer mammograms or the elimination of early screening programs for women under age 50 offered through state-administered breast cancer screening programs.

According to respondents, California, New York, Florida, Illinois and Michigan are among those states that have made changes in their state's breast cancer screening programs since the USPSTF released its guidelines.

"Budget cuts are a reality, but we are concerned that the new USPSTF guidelines may be making it easier for state government-funded programs to stop providing mammograms to women under the age of 50 who may need to be screened," said Forum speaker Barbara Cicerelli, Health Program Coordinator, San Francisco Department of Public Health. "Fortunately for women in San Francisco, under our Healthy San Francisco program, the San Francisco Department of Public Health continues to provide mammograms to women under the age of 50."

In addition to limiting access, the USPSTF-recommended guidelines may be the reason fewer women under the age of 50 are seeking mammograms. Twenty-four percent of survey respondents report a decrease in the number of women under the age of 50 being screened or seeking appointments for mammograms at their facilities. According to some of these survey respondents, many women who were already reluctant to have a mammogram are using the guidelines as their rationale to put off screening.

"We are concerned that some women may simply accept the new recommended guidelines as standard – not taking into consideration their own health history and other breast cancer risk factors," said Hurlbert.

The new USPSTF recommendations address limitations with current mammography technology and the level of scientific understanding about breast cancer disease progression, aggressiveness, and likelihood of metastasis. That is why the Avon Foundation for Women continues its commitment to fund cutting-edge research to develop new tests for more accurate risk assessment, to better determine which women benefit from mammography, ultrasound or MRI screening, and accelerate advances in tumor analysis technology to better determine the appropriate level of aggressiveness for treatment.

"The decision as to when and how often to have a mammogram is between a women and her health care provider," said Hurlbert. "We believe every woman regardless of income or age should have access to early breast cancer screening services and education, as well as quality treatment."

The Avon Foundation for Women along with other expert groups, including the American Cancer Society, American College of Radiology and Susan G. Komen for the Cure, supports current mammography guidelines starting screening at age 40 until better alternatives are developed.

The 2010 Avon Foundation Breast Cancer Forum brought together more than 275 of its grantees, including breast cancer community health educators, patient navigators, nurses and physicians from all 50 states to participate in discussions about programs that enable women to access early detection programs and breast cancer treatment.

Collectively, this network of Avon Foundation for Women-funded programs educates more than 1,000,000 people each year on breast health care, links 150,000 women to mammography screening and navigates thousands of breast cancer patients through treatment and care.