As the debate over when to begin screening mammography in women rages on, the United States Prevention Service Task Force (USPSTF) added fuel to the fire by releasing a new recommendation statement in the November 17th issue of the Annals of Internal Medicine. Applying to women aged ≥40 who are not at an increased genetic risk or have had chest irradiation, the USPSTF now recommends biennial screening in women between ages 50-74. In February 2002, the task force first recommended that annual or biennial screening start at age 40; however, in a revised statement, “The USPSTF recommends against routine screening mammography in women aged 40 to 49 years.” It adds, “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms.” Additionally, regarding screening mammography in women 75 years or older, the evidence is lacking and the risk/benefit ratio has not been fully determined.
Predictably, there has been both supporting and dissenting response from the medical community. In a statement from the American Cancer Society released yesterday, it “continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40.” The chair of the American College of Radiology’s Breast Imaging Commission had a more stern tone in her response. Dr. Carol Lee stated, “These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years.” However, the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network, all supported the newly released USPSTF guidelines.
There is little doubt that the recommendations would result in billions of dollars of savings in medical costs, and though there are always charges of political motivation when guidelines such as these are released, physicians should always use clinical acumen and adequately weigh the pros and cons of what promises to be continuous topic of discussion and debate.
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