By June Spence

On November 16, 2009, the U.S. Preventive Services Task Force (USPSTF) recommended new guidelines on screening for breast cancer, including mammography and breast self-exams. The guidelines were met with considerable debate. “Very smart, reasonable people review evidence and see different things,” says Duke breast oncologist Gary Lyman, MD.

New guidelines, new controversies— just give us the facts, please!

“Any recommendations regarding screening -- whether for breast cancer, prostate cancer, lung cancer, or others -- are going to be met with differing opinions because the recommendations ultimately are based on differing value judgments,” explains Duke radiologist Daniel Sullivan, MD, who was a member of the 1997 NIH Consensus Panel that considered this same question (whether or not to recommend breast screening for women ages 40 to 49). “What is important to one person may not be as important to another, in terms of risks and benefits.”

“It is a complicated and complex issue and many well-respected experts have strong opinions,” says oncologist Amy Abernethy, MD, who heads the Duke Cancer Center Research Program.

While physicians and researchers will most likely continue to debate the issue, there are a few questions that women can get answers to now:

The discussion and debate regarding mammography guidelines can be confusing. What do the experts agree upon?

According to Lyman, Sullivan, and Abernethy, there are several points that most physicians seem to agree upon:

• No screening test is perfect, and we always need to develop better ones.
• Although we have made progress in our knowledge of breast cancer, we need to know more so that we can prevent occurrence. Until that time, we must continue our quest to determine how to treat every woman’s breast cancer in the most effective way possible.
• Without a doubt, every woman should be familiar with her own breasts and should report any changes or concerns to her physician.
• Each woman should talk to her physician about mammography and should be allowed and encouraged to make her own decisions about whether or not to have a mammogram.

What do the new USPSTF guidelines recommend?

In terms of traditional mammography, the task force recommends against routine screening mammography in women ages 40 to 49; their guidelines say the decision to start regular, biennial screening mammography before the age of 50 should be an individual one and take into account the patient context, including her judgement about specific benefits and harms.

For women ages 50 to 74, the task force recommends mammography screening every other year. The task force also concluded that there is not sufficient evidence to warrant screening mammography for women 75 years and older.

The task force concluded that there was also insufficient evidence to warrant clinical breast exams and also recommended against clinicians teaching women how to perform breast self-exams.

Lastly, the task force concluded that there was insufficient evidence to assess the potential benefits and risks of digital mammography or magnetic resonance imaging (MRI).

What mammography guidelines do other organizations recommend?

Many groups -- the American College of Radiology and the Society of Breast Imaging, the American Cancer Society, the American Medical Association, the National Comprehensive Cancer Network, the Canadian Task Force on Preventive Health Care, and the American College of Obstetrics and Gynecology -- recommend that women ages 40 to 49 continue to have yearly or every other year mammograms.

The American Academy of Family Physicians recommends that decisions about mammography in women ages 40 to 49 should be based on an individual’s risk for breast cancer, while the World Health Organization recommends mammography every one to two years for women ages 50 to 69.

Do the new USPSTF guidelines deny any woman the ability to get a mammogram?

No. The task force doesn’t say that women should avoid mammograms. Instead, the task force “encourages individualized, informed decision-making about when to start mammography screening.”

The recommendation against routine annual screening does not apply to those women who are at an increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation.

Will insurance continue to pay for mammograms for women ages 40 to 49?

Most likely. On December 3, 2009, the Senate approved an amendment to its health care reform legislation that would require health insurers to cover mammograms for women ages 40 to 49. At the time of this article’s publication, the health care reform bill was not yet final.

What is the USPSTF?

The U.S. Preventive Services Task Force is sponsored by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health & Human Services.

The task force makes recommendations about which preventive services for numerous diseases should be incorporated routinely into primary medical care and for which populations. The task force does not set federal policy and it does not determine what services are covered by the federal government.

Who are members of the USPSTF?

The USPSTF is a task force that comprises physicians specializing in a variety of areas, including epidemiology, internal medicine, and family medicine. View a complete list of task force members and their credentials.