HOW WE SEE IT: Did Task Force Do More Harm Than Good?

Posted: November 24, 2009 at 3:14 a.m.

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Thanks to an aggressive public-awareness campaign, women have never been more knowledgeable about breast cancer. Events such as the Susan G. Komen Race for the Cure (which raised $1 million in Rogers last spring) have attracted thousands of participants. The color pink has become synonymous with the fight against breast cancer. The disease frequently shows up in headlines, and statistics about it are well publicized.

Throughout this campaign,women - particularly those 40 and older - have been urged repeatedly to get annual mammograms and occasionally examine themselves for lumps. Seems like good advice to us.

Last week, however, the U.S. Preventive Services Task Force, an independentpanel of doctors, announced routine mammograms are not necessary for women younger than 50 who are at average risk for breast cancer; after 50, women should get a mammogram every other year. The task force also recommended against teaching breast selfexamination.

This sudden shift in prevention guidelines highlights an ongoing debate about the benefits versus the risks of mammography.

True, mammography is not perfect. Occasionally it falsely diagnoses cancer, and sometimes it fails to detect a tumor. There is also the risk of over-diagnosis, which means that a patient is persuaded to undergo costly and stressful treatment that in actuality is unnecessary (up to 10 percent of all cancers found through mammograms are thought to be harmless).

Neither scenario is desirable.

Nevertheless, women should not be deterred from getting a mammogram. Until a better screening method is invented - and we hope someone out there is working on one - the mammogram is still the best tool available for early detection.

Studies show that the older women get, the more important a mammogram becomes. According to the task force, one out of every 1,900 mammograms of women in their forties saves a life, whereas one out of every 337 mammograms of women in their sixties saves a life.

It’s important to note that the new guidelines have not been universally accepted by the medical community. The American Cancer Society continues to recommend annual mammograms starting at age 40.

For various reasons, the new guidelines worry us.

For one thing, they muddy up the public’s perception of the importance of breast-cancer screening and unnecessarily confuse many people. Women who already were doubting the effectiveness of the mammogram might be convinced to forgo it altogether, which would be a step backward in the fight against cancer.

Equally concerning is how these guidelines will affect the insurance industry. Will insurance companies still cover annual mammograms, or will they reject claims based on the advice of this task force? Are these recommendations based primarily on what’s best for our health or on a mandate to cut health-care costs?

More than 193,000 American women will develop breast cancer this year, and 40,000 will die of it. This is still a serious health issue.

For all the controversy that the task force stirred up with its latest guidelines, it made at least one point worth remembering: “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.”

Bingo. The bottom line is this: Each woman knows her own body best, and should make the decision that’s right for her based on family history and consultations with her doctor.

Opinion, Pages 5 on 11/24/2009

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