For years, physicians and medical organizations have been espousing the benefits of annual mammograms as one way women can take charge of their health. Then in October 2001, an article in the British journal Lancet questioned whether this breast-screening technique had any impact on breast cancer deaths. This report spurred months of controversy within the medical community and led to much confusion among women. To allay some of the confusion, several organizations took extraordinary steps: At the end of January, 10 health organizations, including the American Cancer Society, joined forces and ran a full-page ad in the New York Times expressing concern about the new findings and urging women to continue to have annual mammograms. At the same time, the editors of HealthNews, a publication of the New England Journal of Medicine, ran a lead story in their February issue advising women not to “spurn” this technique. The authors concluded, “There is widespread agreement that appropriate treatment for breast abnormalities uncovered by mammography does save lives.”
Finally, in late February, new federal guidelines for breast cancer screening were revealed that now represent the government’s official policy on mammograms. To underscore the importance of this issue, health officials held a press conference to announce the new guidelines, which not only strongly recommend mammography but also lower the age at which women should start getting such tests.
“The federal government makes a clear recommendation to women on mammography,” said Health and Human Services Secretary Tommy G. Thompson on February 21. “If you are 40 or older, get screened for breast cancer with mammography every one to two years. While developing technology certainly holds the promise for new detection and treatment methods, mammography remains a strong and important tool in the early detection of breast cancer. The early detection of breast cancer can save lives.”
Thompson said the new guidelines were based on updated recommendations made by the U.S. Preventive Services Task Force (USPSTF), a leading independent panel of experts on prevention and primary care who work in the private sector. The panel’s recommendations were made after reviewing eight randomized controlled trials of mammography that studied women over a period of 11 to 20 years.
The new guidelines build on previous USPSTF recommendations for breast cancer screening. Earlier guidelines published in 1989 and 1996 had endorsed mammograms for women 50 and older. The 2002 guidelines advise regular mammography for women 40 and older. However, the guidelines do acknowledge that the strongest evidence of reduced mortality from breast cancer has involved women between 50 and 69 years of age. The guidelines also contain a caveat that mammography is associated with some risk, given that false-positive results may lead to unnecessary biopsies. The risk declines as women get older.
In a similar show of support for breast cancer screening through mammography, the National Cancer Institute (NCI) issued its own endorsement. “Early detection of cancer saves lives, and we continue to recommend mammography for women in their 40s and older,” said NCI Director Andrew von Eschenbach, MD. ‰