New mammogram recommendations spark controversy

November 16, 2009 by DELTHIA RICKS / delthia.ricks@newsday.com

In a dramatic reversal that has stirred wide debate, a key government panel has recommended women should begin mammograms at 50 - not 40.

The decision by the U.S. Preventive Services Task Force, a panel of experts that advises doctors on medical care, overhauls a treatment philosophy dating back 20 years that says screening for tumors should begin at 40 for women of average breast cancer risk.

The group also says women between the ages of 50 and 74 need to be screened less frequently - every two years as opposed to annually - and that women 75 and older can avoid the test altogether.

Another startling recommendation: Doctors should no longer teach women breast self-examination because it serves little benefit. All the guidelines appear in Tuesday's issue of the Annals of Internal Medicine.

The potential for overtreatment is driving the new guidelines, said panel member Dr. David Grossman. Mammography also has the potential for false positives, he said Monday, which can lead to psychological anxiety amid the aggressive medical work-up for what turns out not to be cancer.

"Our data is from studies involving thousands and thousands of women," Grossman said. "Those data were not available in 2002. We have much more information about potential harms of breast cancer screening."

Radiation risk did not play prominently in the panel's view of harmful effects, added Grossman, medical director of the Group Health Cooperative in Seattle. The task force is convened by the Agency of Healthcare Research and Quality, a division of the Department of Health and Human Services. It influences doctors but also insurance companies, which generally cover screening.

The panel's decision is at odds with numerous physicians, some advocacy groups and the American Cancer Society, which has long supported the benefits of mammography. Monday, the society announced it will abide by its long-standing recommendation that annual screening should begin at the age of 40.

"As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," said Dr. Otis Brawley, the cancer society's chief medical officer.

The task force's decision was not based on new scientific research but an analysis of existing data, leaving it open for criticism from some observers. "There's no new information that has come to bear on this issue," said Dr. Clare Bradley, medical officer for the cancer society's Eastern Division. "We have no new clinical studies that we should look at."

The decision was opposed on Long Island by the Adelphi NY Statewide Breast Cancer Hotline and Support Program, but in Manhattan, it was applauded by Alice Yaker, executive director of SHARE: Self Help for Women With Breast or Ovarian Cancer.