Conflicting Mammogram Guidelines: What to Do

Managing your health is difficult enough when you know the proper guidelines and recommendations. So what do you do when you learn of new, but conflicting, health information? Who do you trust? How do you know if new research is based on well-founded claims, or if it’s making lofty conclusions? I believe people should approach health questions like they would approach buying a car. Do your research, question whether the information you’ve found comes from a credible source, and, if all else fails, ask a trusted expert.

In 2009, a controversy erupted over new breast cancer screening guidelines published by the United States Preventive Services Task Force (USPSTF), an independent panel of experts appointed by the Department of Health and Human Services to examine the cost and health benefits of annual mammograms for women starting in their 40s. They stated that women in their 40s do not benefit from yearly mammograms, and should instead start screening at age 50. The Task Force also suggested that women older than 50 may only need them every two years instead of every year. By spacing out mammograms, the USPSTF concluded that it would reduce costs without compromising the health of women. What struck me as odd was the fact that, just a few years prior, the same group (with different members) recommended that women have mammograms every 1-2 years starting at age 40.

So, I did my research, checked if the information came from a credible source, and asked an expert. The expert was Dr. Christina Giuliano, Director of Breast Imaging at the Maimonides Breast Cancer Center. “The key to treating breast cancer is finding it early – that’s the whole goal,” emphasized Dr. Giuliano. “Mammograms can do that for some women, and it’s irresponsible for them to be told otherwise.”

The argument made by the USPSTF was that annual testing, much of which is funded by the already stressed Medicare and Medicaid systems, wasn’t cost effective. Instead, they suggested that patients who are at a higher risk for breast cancer, or have family history, receive annual exams. “Unfortunately, 80% of women do not have breast cancer in their family,” states Dr. Giuliano. “The vast majority of breast cancer patients are not pinpointed as ‘high-risk.’” Additionally, according to Dr. Giuliano, 40% of lives saved from cancer detection by a mammogram are those of women in their 40s. By delaying screening until the age of 50, tumors would have a significant amount of time to potentially grow and spread, leaving women with more difficult cancers to treat.

I asked Dr. Giuliano about the reputability of the Task Force, inquiring how a group of experts could have suggested something that might, in fact, be detrimental to women’s health. As she pointed out, the Task Force consisted mainly of public health officials and primary care physicians. When this suggestion was made, no radiation oncologists, breast surgeons or breast imaging specialists sat on the USPSTF. Looking at the American College of Radiology, the Society of Breast Imaging, American College of Surgeons, American Cancer Society, American Society of Breast Diseases and the American College of Obstetrics – all maintain their current advice, going against the Task Force’s instruction.

“While mammograms aren’t perfect, it is absolutely the best test,” emphasizes Dr. Giuliano. “It lowers the mortality rate and increases the patient’s treatment options.” If the cancer is smaller, it is less likely to have spread. That can mean the difference between receiving a lumpectomy instead of mastectomy. Less intensive treatments of radiotherapy and chemotherapy may be necessary, if the tumor is found at an earlier stage. “Reducing the mortality from breast cancer by nearly 30% since the 1990s (after introduction of widespread mammographic screening) has been one of our major accomplishments in medicine,” states Dr. Giuliano.

A big problem was the news coverage. The media focused on the Task Force’s guidelines, but not the goal it was trying to achieve. The USPSTF chose to focus on cost, a very important concern when providing mammograms to millions of women across the nation. The media neglected to cover this, focusing instead on the health outcomes, and not the additional goal of cost-effectiveness. Without this distinction, many women and doctors became confused on what guidelines to follow.

Remember, it’s always ok to question health information. Sometimes you have to look a little deeper than the headline of a news story. You need to be educated on all sides of an issue in order to make a clear decision on where you stand. Think of it this way, would you automatically believe a car ad that claimed “Brand NEW Car – 75% off list price. BUY BUY BUY!!!”?

Yeah – I didn’t think so.