December 22, 2009
Joint Statement from University Hospitals Case Medical Center and MetroHealth Medical Center in response to the new USPSTF mammography guidelines:
The U.S. Preventive Services Task Force (USPSTF) announcement regarding screening mammograms and associated media attention caused much concern and some confusion for women who wonder if they should continue to receive mammograms. In response to this, University Hospitals Ireland Cancer Center now University Hospitals Seidman Cancer Center and MetroHealth Cancer Care Center are making recommendations for women regarding mammograms. We are continuing to recommend screening mammograms each year for women of age 40 and older.
In November, USPSTF recommended against routine screening mammograms in women aged 40-49 and recommended mammograms only every two years for those 50 and older. The USPSTF stated that the decision to start regular, biennial screening mammography before the age of 50 should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
It is important to remember that several groups of physicians and scientists have issued recommendations regarding the importance of screening mammograms, and it is only natural that the differing recommendations have led to confusion. The difference between recommendations comes from varying assessments of lives saved versus the cost and potential harmful effects of screening. Many groups, including American Cancer Society and Society of Breast Imaging, continue to favor annual mammograms beginning at age 40, and that is what we are recommending for our patients. Of course, a person’s particular health status might alter recommendations for an individual.
Breast cancer is an important health problem that causes not only cancer deaths but serious illness. Breast cancers caught earlier by screening mammograms are more likely to be cured and are less likely to require chemotherapy or as extensive surgery. This advantage of screening was not addressed in the recent USPSTF recommendations. Furthermore, many centers now use a newer, digital mammogram technique, which provides better screening in younger women. Many of the studies reviewed by the USPSTF to make the recommendation against screening did not use digital mammograms and therefore may have underestimated the benefit of screening. Overall, the recommendations from USPSTF were based on statistical predictions and not new scientific data. As with any medical study, this analysis still requires the interpretation of experts.
All experts, including those serving on the USPSTF, agree that screening mammography saves lives, even in the 40-49 year old age group where mammograms are less accurate. Although mammograms are not perfect, they are the best screening tool for breast cancer. Research, like that being done in Cleveland, may help find better tools. This research may help understand which patients are at low enough risk that screening can be done less often or not until after age 49. Until then, women 40 and older should plan to continue to be regularly screened, and to discuss issues they may have with their physician.
University Hospitals Case Medical Center and MetroHealth Medical Center are committed to finding and fighting breast cancer, and recommend that women age 40 and over obtain yearly screening mammograms.