Panel: Mammograms under 50 downplayed

RALEIGH, N.C. – An influential federal panel said most women under 50 do not need routine mammograms – a direct contradiction to longstanding advice from doctors and cancer groups.

In addition, the U.S. Preventive Services Task Force said there’s no evidence breast self-exam leads to fewer deaths, and the group suggested doctors quit teaching women how to conduct the examinations at home.

The recommendations drew immediate outrage from many researchers, doctors and patients, who cited personal experience that the screening methods caught otherwise undetected cancers and led to successful treatment. Most authorities call for regular screenings after age 40.

Some questioned the timing of the recommendations, coming as lawmakers in Washington debate ways to save money in the nation’s health care system, possibly by curbing procedures or treatments that have no scientific evidence of benefit.

“This makes no sense to me,” said Dr. Etta Pisano, a mammography researcher at the University of North Carolina-Chapel Hill who published an influential national study in 2005 that prompted wider use of newer, digital mammography technology. “I am tired of the debate over this. There is plenty of evidence that mammography reduces breast cancer mortality.”

Pisano cited studies showing even mammogram screenings done by older technology reduce death rates by at least 15 percent for women in their 40s.

But the task force looked at larger population studies and concluded the evidence of benefit isn’t convincing in the younger age group, particularly when weighed against the potential harm of false alarms, unnecessary radiation exposures and caustic treatments for relatively non-aggressive cancers.

“Although false-positive test results, overdiagnosis and unnecessary earlier treatments are problems for all age groups, false-positive results are more common for women aged 40-49 years,” the task force reported.

The task force, a panel of public health doctors and academic medical center experts in prevention and primary care, has issued guidelines since it was formed in 1984. Its recommendations have helped frame the advice issued by professional societies, health organizations and medical quality review groups.

But the current findings are meeting strong resistance. The American Cancer Society, which has its own screening recommendations, issued a statement Monday reaffirming its call for women to begin regular mammography at 40.

“The American Cancer Society acknowledges the limitations of mammography, and we remain committed to finding better tests,” Dr. Otis W. Brawley, chief medical officer of the cancer group, said in a prepared statement. “In fact, data show the technology used today is better than that used in the studies in this review. … As scientists work to make mammography even more effective, the American Cancer Society’s medical staff and volunteer experts overwhelmingly believe the benefits of screening women aged 40 to 49 outweigh its limitations.”

Dr. Gary Lyman, director of health services outcome research at Duke University Medical Center and a member of other medical panels that have set breast cancer screening guidelines, said he fears that women will be confused about the conflicting recommendations.

Prevention efforts are flagging already, Lyman said, so a mixed message could further erode progress.

“Women out of sheer confusion or uncertainty will not do routine mammography,” he said, noting that early detection has long been a proven life-saver. Cancers that are caught early, before they spread, are easier to treat and can often be wiped out.

Lyman and other doctors questioned the motivation of the task force, because one of the topics in the national health-care debate is the high cost of unnecessary treatments and scans. Just last month, questions about the benefits of prostate cancer screenings ignited a similar furor.

“In the future, as a society, we have to talk about resources,” said Dr. Lisa Tolnitch, a surgeon in Raleigh who specializes in breast cancer.

“The question of doing mammography, ‘Can you in a dollar-and-cents way prove you save lives?’ That’s a hard thing to pin down. Then you have to say, ‘How much is a life worth?’ That’s what we’re talking about. If it’s your life, it’s worth a lot to you.”


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