At a recent community education program, Stanford experts on women’s
cancer disagreed with controversial new
federal guidelines on breast cancer screening. The new guidelines,
released in November by the U.S.
Preventive Services Task Force, would delay a woman’s first
mammogram by 10 years, reduce future screenings from annual to every
other year, and end them after age 74.
“It’s critical that we don’t have limits on our resources while this
gets sorted out.”
Instead, presenters for the program, “Controversies in Screening for
Women’s Cancer,” said they’ll continue to support older breast-cancer
screening guidelines,
from the American Cancer Society in 2003, which call for annual
mammograms starting at age 40.
The new guidelines apply only to women at average risk for breast
cancer, not high-risk women.
Debra
Ikeda, MD, director of Stanford University Breast Imaging, said she
disagreed with the Task Force’s conclusion that the number of lives
saved by annual mammography screening for women in their 40s was
outweighed by the risks of screening for that age group. “Women need to
know that [with routine mammograms] there may be false positives and a
need for biopsies,” she said. “But women should make that choice for
themselves, with a doctor’s help.”
Ikeda, a professor of diagnostic radiology, is concerned that the new
guidelines will lead to some women missing out on a cancer being
detected early, when it’s more treatable. “With that longer interval
between mammograms,” she said, “we’ll start seeing more higher-stage
cancers.”
While possible over diagnosis of breast cancer is also a risk of routine
mammograms, Ikeda said, “the problem I have is, how do I know which
cancer is going to kill a woman and which one won’t? I don’t want to
take that chance.”
The real problem, she said, is there is no reliable test to distinguish
deadly breast cancers from those that won’t cause harm. Also, she said
the actual benefit of annual mammograms for women in their 40s is likely
greater than the USPSTF determined, since its data couldn’t have fully
reflected recent advances in breast imaging technology. .
Professional societies, including the American
Cancer Society and the American
College of Obstetricians and Gynecologists, also oppose the new
breast-cancer screening guidelines and back the previous guidance.
Professor of medicine-oncology Robert
W. Carlson, MD, also a presenter at the program, said he, too,
supports the older guidelines. He said he is particularly concerned that
the new guidelines could lead insurers to limit coverage of breast
cancer screening.
Still, Carlson said the Task Force’s new breast cancer guidelines
represent a difference in opinion and values. From a policy perspective,
he said, screening every two years starting at age 50 could be
considered reasonable given the need to use limited resources for the
greatest benefit. Annual screening starting at age 40 would require
approximately 50,000 women to be screened, and millions of dollars
spent, for every life saved, he pointed out.