Draft recommendations on screening mammography always provoke debate

The launch of new guidelines on mammography never fails to renew the controversy about the advantages and possible disadvantages of this procedure.  

The latest draft guidelines Preventive Services Task Force (USPSTF) are no exception. Several expert bodies have taken contradictory positions on them. You can give your opinion, too, if you hurry - Public comments on the draft closes today.

Mammography screening is performed on healthy women to detect the hidden breast cancer. Some expert groups say women should start having regular mammograms at age 40, others set the age of onset at 50. The age at which women should stop having mammograms is also discussed.

The USPSTF is an independent panel of experts in primary care and prevention. It is responsible for making recommendations on the use of preventive services. Its final recommendations on mammography, completed in 2009, said that women between the ages of 50 and 74 should be tested every two years. 

The new draft recommendations are similar to those published in 2009, although there are some differences. Age starting and ending mammography screening are the same. The new project, says there is insufficient evidence to recommend for or against the use of a new technique called 3-D mammography for screening. The task force also says there is not enough evidence to recommend that women with dense breasts who are at greater risk of breast cancer should have an ultrasound or MRI in addition to mammography screening.

The American Cancer Society and other medical organizations recommend that women begin having regular mammograms at age 40. The USPSTF, however, advises women between the ages of 40 and 49 to talk to their doctors to make their own decisions based on the detection of how they evaluate the advantages and disadvantages of possible mammogram.

Many women and their doctors do not think much about the possible harms of screening mammography. A statistical model included in the USPSTF project shows that annual mammograms from 1,000 women 40 years would prevent one death compared to 1,000 women of the same age who did not have mammograms (7 vs 8). But screening in this age group 576 also trigger false positive tests, 58 unnecessary breast biopsies, and two other tumors over-diagnosis (20 against 18) have not affected the health or longevity.

A study recently published in the journal Health Affairs study estimates that the false positive mammograms and over-diagnosis of breast tumors costs the health system $ 4 billion a year. This figure is much higher than previous estimates and should be part of the national conversation on the use of screening mammography.

While annual savings lives, there are many false positive mammography scans and a few more-diagnosed tumors. Individual women may weigh these figures differently and make different moral judgments to decide to start having mammograms at age 40.

For women aged 75 and older, the USPSTF panel keeps saying that there is not enough evidence to recommend for or against routine mammograms. Other experts suggest that mammograms make sense to women is expected in this age group living 10 years or more, on the basis of good health.
You can comment on the USPSTF draft until 20:00 Eastern time today. It is expected that the final recommendations will be published in autumn 2015.