Cancer screening confusion

The American Cancer Society's has long recommended that women begin annual breast screening at age 40. A new government task force, however, has issued recommendations that say women should undergo mammography every two years beginning at age 50. The panel of scientists and physicians also says breast self-exams do no good.

The panel says screening for breast cancer before age 50 results in too many false alarms and unneeded biopsies without substantially improving women's odds of survival. The panel developed the guidelines after six research teams around the world studied federal data on cancer and mammography to create mathematical models of what would happen if women were screened at different ages and time intervals.

The U.S. Preventative Services Task Force's guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations that would justify undergoing mammography more frequently and earlier than 50.

As with all new medical recommendations, there are many more questions than answers. The best course is to ask one's health-care provider how the new recommendations apply to one's own circumstance.

It does not escape notice that the American Cancer Society's cancer-screening recommendations have not changed in the face of this new recommendation from the government panel. The cancer society feels the benefits of screening outweigh any potential harms.

Responding to the recommendations, Health and Human Services Secretary Kathleen Sebelius said the doctors and scientists on the task force "do not set federal policy, and they don't determine what services are covered by the federal government."

While the panel's recommendations do not apply to women who are considered at greater risk of developing breast cancer, 70 to 80 percent of women who get breast cancer have no family history of the disease, according to the American Cancer Society. Are women ages 40-49 willing to run that risk? Are their health-care providers?

Moreover, will cost-conscious insurance companies alter their coverage of this screening to conform to the task force findings? One industry group says coverage isn't likely to change. Incidentally, Utah is the only state that does not mandate that insurance companies cover routine mammograms.

This drastic reversal in breast-cancer screening recommendations is stunning. There is no harm in women continuing to conduct breast self-exams. Anecdotally, many people know women who discovered lumps in their breasts during self-exams that turned out to be malignant. Still others know at least one person who was diagnosed with breast cancer before age 50 via mammography.

Statistically, however, the risks of getting breast cancer go up with age. About two-thirds of women with invasive breast cancer are 55 or older when the cancer is detected, according to the American Cancer Society. This would lend some credence to the panel's recommendations.

Part of the panel's recommendations hinged on the risks posed by mammography, such as false positives, unnecessary tests and how much extra radiation women were exposed to during false-positive testing. That was weighed against the benefits of mammography, such as how many cancers were detected and how many lives were saved.

While the math make might sense, practitioners will have to weigh the recommendations against what is best for their patients' physical health and mental well-being. Understanding that mammography is not perfect, there are numerous incidents in which the test has saved lives. Seemingly, patients deserve the use of the best available tools to combat a disease that is a leading killer of women.