Before we discuss the updated guidelines by US Preventive Services Task Forces (USPSTF), lets first understand who USPSTF is. This task force is the leading independent panel of private-sector experts in prevention and primary care sponsored by the Agency for Healthcare Research and Quality (AHRQ). The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the “gold standard” for clinical preventive services.
After a rigourous review of literature, this task force made the following recommendations:
- Routine screening mammography in women aged 40 to 49 years is not recommended. 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.
Grade: C recommendation (Means there is at least modest certainty for recommending against)
- Screening mammography in women aged 50 to 74 should be done every other year.
Grade: B recommendation (Means there is at least moderate benefit for recommending this)
- Current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older
Grade: I recommendation (Means we don’t have enough evidence to say for or against)
- The task force recommends against teaching breast self-examination (BSE).
Grade: D recommendation (Means there is moderate to high certainty for recommending against)
USPSTF has no obligation to the Government or any entity regarding their recommendation. It is just based on latest body of evidence. One may think that how a screening test can be harmful. In fact the evidence concludes that risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety and pain. And mammograms can findÂ lesions that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.
However, if one have risk factors for breast cancer, such as, family hostory of breast cancer, nulliparous, late menopause, dense fibrocystic breast, etc, the risk of added testing may be weighed against finding cancer earlier. Such benefir-risk assessment should be done individually on patient-by-patient basis.
We hope such recommendations does not affect insurance coverage for yearly mammogram who may need it due to higher risks for breast cancer. Per the White House blog, Dan Pfeiffer, the deputy communications director, wrote that women who are currently getting mammograms under Medicare will continue to be able to get them. (Published in NY Times – November 19, 2009).
Only time will tell the real implications…
Latest update fro m New England Journal of Medicine (11/30/2009):
On Mammography – More Agreement than Disagreement. This article summarizes the conflict very nicely.
Be concerned and participate in breast cancer walk promoting awareness about the disease.