New Mammogram Recommendations

November 17, 2009

The U.S. Preventive Services Task Force (an independent, gov't appointed panel) has released a paper that changes the current suggestions for mammograms. The report suggests that women between the ages 40 and 50 should not have regular yearly mammograms, and it suggests women over 50 should only have mammograms every other year. The panel's recommendation is the next chapter in the screening guidelines revision story that was sparked two weeks ago when the American Cancer Society first hinted that they would change their recommendations and then retracted that statement and said their recommendations would stay the same. Confusing, huh?

Again, the problem here is that the message is very difficult and nuanced. By simply reading the headlines (and sometimes the text of the news articles), one might conclude that screenings - the actual mammogram or PSA test or other screening test - are harmful to one's health. THIS IS NOT THE CASE. A great explanation came in the fifth paragraph of the Washington Post article (11/17/2009; Rob Stein) - "Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy." This statement explains the nuance of the problem; the mammograms are not bad for one's health. The danger lies in the response to the mammogram when either a false positive is produced and the patient is treated OR a very-slow-growing and non-threatening cancer is detected and treated. Treatment for cancer is not benign (one of the basic tenets of survivorship). The side effects associated with the various treatments can be overwhelming and quite harmful to the body. The new guidelines are responding to that very issue. The new guidelines are actually saying - a mammogram may detect a tumor that will cause less harm to your body than the treatment would receive to respond to that tumor.

Unfortunately, even these explanations don't end the story. These screening guideline debates and changes are aimed at reducing the burden of disease on the entire population. In essence, the very intelligent scientists and doctors making these recommendations are suggesting that screening too often for certain cancers is causing unnecessary pain and suffering on the population level, and on a whole, the panel believes we can reduce the collective pain by reducing the screenings; the recommendation to reduce the number of mammograms is targeted at the entire population - not the individual.  The panel is saying that on-the-whole, we should perform fewer mammograms, and they have suggested a few sub-populations in which we should reduce the frequency of the mammograms in order to achieve that goal. The recommendations do not necessarily fit each patient's individual needs.

How should you interpret these recommendations as a survivor? If you are a survivor, your risk of a second or recurring cancer is higher than persons who have not already been diagnosed and treated for cancer. Once you are a survivor, your case is unique. You must talk to your doctor, and with the help of your doctor, you should develop a screening plan that fits your individual needs. This is what survivorship is all about! Once you are a survivor, your needs are unique and highly specialized, so you need to develop a self-awareness and an open relationship with your care team, so you can be sure to tackle each issue (like screenings) in the way that best ensures and improves your individual health.

Read the Wash Post article about the panel's new guidelines

Read the AP story on MSNBC

Read the New York Times article about the panel's new guidelines

by Christian McEvoy, MPH, Director of Survivorship Information Connecticut Challenge

Site Map