MAMMOGRAMS
U.S. overhauls breast-test advice
November 17, 2009
Stephanie Nano
Marilynn Marchione
NEW YORK–Most women don't need a mammogram in their 40s and should get one every two years starting at 50, a U.S. government task force said Monday. It's a major reversal that conflicts with the American Cancer Society's long-standing position.
Also, the task force said breast self-exams do no good and women shouldn't be taught to do them.
For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.
But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women's odds of survival.
"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chair of the panel.
The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.
Experts expect the task force revisions to be hotly debated, and to cause confusion for women and their doctors.
The guidelines and research supporting them were released Monday and are being published in Tuesday's issue of the Annals of Internal Medicine.
But Dr. Martin Yaffe, a senior scientist at Sunnybrook Health Sciences Centre, believes it remains a good idea to screen women in their 40s.
While Ontario's screening program doesn't accept women in their 40s now, it should, Yaffe told the Star's Paul Moloney.
"About one-sixth of the deaths due to breast cancer occur in women who develop the cancer in their 40s," he said.
"We don't know what causes breast cancer so really the only way we can reduce mortality is to find it early when it can be treated effectively.
"The estimates have been anywhere from 15 per cent to over 40 per cent reduction in mortality through screening. That comes about by finding the cancer early."
Yaffe said a private member's bill supporting screening of women in their 40s is currently before the Ontario Legislature.
It would be "a tragedy" if that bill lost support due to the new U.S. guidelines.
"I think women in Ontario have really been deprived of the opportunity to take advantage of a high quality screening program for many years already. If this prolongs that, I think it's going to be responsible for women dying of breast cancer who don't need to," he said.
Yaffe estimated about 400 women in Ontario die each year of breast cancer that they get in their 40s. "About 100 of those women could be saved if they were screened regularly in their 40s," he added.
Toronto Star