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Mammography Guidelines Debate: To Change or Not to Change

As a breast cancer surgeon and investigator, I join the chorus of voices, including the American Cancer Society, that we should NOT change our criteria for screening mammograms. There is strong scientific evidence that early detection through screening mammograms has reduced the mortality rates of women with breast cancer. Why change? Is the evidence presented by one group of scientific advisors compelling enough to make fundamental changes? If the data were so compelling, why are so many patient advocacy groups and medical groups making public statements to the contrary?

Nancy Brinker, the Founder of Koman Foundation and a breast Cancer Survivor was quoted in the Washington Post (November 24th,2009) stated at the National Press Club that the U.S. Preventative Services Task Force recommendations have taken a tremendous toll, and I believe they set us back. After all we’ve done to urge people to get screened, now they hear maybe they shouldn’t bother. That’s dangerous.

I am a member of the Patient Advocacy Foundation. Below is the public statement the PAF has made.

Statement by the Scientific Advisory Board of the Patient Advocate Foundation/National Patient Advocate Foundation on Changes to the USPSTF Mammography Guidelines

WASHINGTON, DC (November 20, 2009) Patient Advocate Foundation (PAF) is a national, non-profit organization that provides case management services to patients diagnosed with chronic, life-threatening and debilitating diseases. Last year, PAF served 48,369 patients and responded to an additional 9.5 million contacts for information. PAF”s companion organization, the National Patient Advocate Foundation (NPAF) is a national, non-profit organization dedicated to the mission of creating avenues of improved patient access to health care through public policy reform at the state and federal levels. The advocacy activities and policy positions of NPAF are informed and influenced by the experience of patients who served by PAF. The PAF/NPAF Scientific Advisory Board has reviewed the recommendations released by the U.S. Preventive Services Task Force (USPSTF) on screening for breast cancer.

While reasonable individuals can come to different conclusions, PAF/NPAF must respectfully disagree with the recently revised recommendations released by the U.S. Preventive Services Task Force. Even though the USPSTF recommendations are for women of average risk, we nonetheless find the potential effects of its recommendations to be troubling. While the Task Force does not establish government policy, we are concerned that private health insurance companies could make coverage decisions based on these recommendations. In 2008, breast cancer was the leading cancer diagnosis of PAF patients. Of those, 25% of all PAF breast cancer patients were between the ages of 40-49 and would be directly affected by these recommendations, stated Nancy Davenport-Ennis, CEO of PAF/NPAF.

The Task Force did not attach great strength to the evidence for its recommendation and noted that mammography would reduce the risk of death from breast cancer by 15 percent both in women in their forties and in women in their fifties, but chose not to recommend annual screening for women in their forties because it would save marginally fewer lives and is associated with more procedures. Moreover, a table in the report clearly shows a meta-analysis favoring screening for women from 40-49 years of age. Recommendations as important as these should not be decided on narrow evidence that is not widely supported by the breast cancer and provider community, Robert Rifkin, M.D., Chair, PAF/NPAF Scientific Advisory Board. Until there is much more conclusive evidence, we continue to join our non-profit colleagues, including the American Cancer Society, Susan G. Komen Foundation, National Comprehensive Cancer Network, and the American Medical Association, in recommending that women over the age of 40 continue regular, annual mammography screening.

“We believe that a measured approach is to continue screening women of standard cancer risk between the ages of 40 and 49 with annual mammography, and to work to improve the accuracy of screening for breast cancer”, stated Dennis Gastineau, M.D., Scientific Liaison to the Executive Board of Directors.

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