Last week, the U.S. Preventive Services Task Force published new guidelines for mammography. What is the task force? According to its Web site, it is an independent panel of government-appointed experts that reviews medical research and makes recommendations on ways to reduce the risk of illness and death. It is funded by the Agency for Healthcare Quality and Research and is very influential in medical guidelines.

These new guidelines apply to women 40 years or older who do not have an increased risk for breast cancer. If you find a lump or if you are in a high-risk category, defined as having a first-degree relative or a personal history with breast cancer, these guidelines are not for you.

Breast cancer is the second-leading cause of death among American women, and it is also the most frequently diagnosed cancer behind skin cancer. Current guidelines were published in 2002 by the task force, and it recommended women have a baseline screening mammogram at the age of 40, followed by a mammogram every one to two years until the age of 50, then yearly after the age of 50. It is also recommended women get a clinical breast exam yearly from their health care provider and to perform breast self-exam.

After reviewing evidence published after 2002, the task force has reversed its position on screening mammography for women in their 40s, and the new guidelines recommend a baseline screening mammogram at the age of 50, followed by biannual exams until the age of 74. They are also recommending against teaching breast self-exam.

What is the average woman to do? There has always been debate about whether to recommend routine screening mammography for women in their 40s. The risks and benefits of screening mammograms need to be weighed against each other. The benefit is the reduction of breast cancer mortality. Risks include the need for additional testing to rule out cancer, including more exposure to radiation, biopsies and, in some cases, surgery. These cost money, are not risk-free and also can cause stress and worry. The majority of additional tests turn up no cancer, and have potentially caused unnecessary worry. 

On the other hand, it can also cause worry to be tested less frequently. Screening mammograms catch small tumors early, and this has proven to save lives. We have seen a decrease in mortality from breast cancer consistently since the early 1990s. How many of us know women in their 40s who have been diagnosed with breast cancer based on a routine mammogram? What if women are concerned about breast cancer and would be relieved by having yearly mammograms? Perhaps it isn’t risk-free not to test either. This dilemma is an example of the challenge of making policy recommendations such as those made by the task force. Even with good evidence and data to support the decision, it is not always clear that it is the best choice for individuals. 

The American Cancer Society and the Susan G. Komen Foundation have stated they will continue to recommend annual mammograms starting at the age of 40. It is very important for women in their 40s to become educated about the potential risks and benefits of screening, and they need to talk with their physician about making the right decision for them. The task force states, “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”

Many providers in Missoula will also continue to use the 2002 guidelines. However, the door has been opened, and with all things medical, time will tell what changes will be made to current practices. This suggested change reminds us that each woman needs to learn about the recommendations and risks, and to discuss the best course for her mammography decisions with her provider.

If you have any questions, please don’t hesitate to call me at 329-5656 or e-mail me at CHouska@saintpatrick.org

Char Houska is a registered nurse, oncology-certified nurse, certified breast care nurse and breast care coordinator at St. Patrick Hospital and Health Sciences Center.