New mammogram guidelines poorly worded, task force admits

Controversy and confusion about the updated recommendations led a House subcommittee to review them.

By — Posted Dec. 15, 2009

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The U.S. Preventive Services Task Force stands by its revised breast cancer screening guidelines. But task force members admitted that the guidance was poorly worded and the revisions should not have been released during the debate on health care system reform.

Task Force Chair Ned Calonge, MD, MPH, and Vice Chair Diana Petitti, MD, MPH, answered questions about the guidelines during a Dec. 2 hearing with the House Energy and Commerce Subcommittee on Health. Dr. Calonge told the subcommittee the revisions are based on scientific evidence and did not take into consideration cost or cost-effectiveness.

The guidelines, issued Nov. 16 and published in the Nov. 17 Annals of Internal Medicine sparked an uproar among the medical community and patients. Much of the controversy surrounds recommendations against routine mammography screening in women younger than 50 and against teaching women breast self-examination. The guidelines also say women 50 to 74 should get a mammogram every two years.

The revisions mark a shift from the task force's previous guidelines, issued in 2002, that recommended a mammogram every one to two years for women older than 40.

Dr. Petitti said the task force's poor choice of words led the public to misinterpret the agency's message. The intended message is that a woman in her 40s should decide whether to have a mammogram based on a discussion with her physician, she said. Mammograms for women in their 40s should not be required, nor should they be denied.

The task force -- a panel of doctors and scientists -- determined that the benefits of regular mammography for women 40 to 49 are small compared with the risks, she said. The benefit-risk ratio becomes more favorable as women age.

Dr. Petitti also said that although the task force recommends against teaching breast self-examination, women should still tell their physicians about any changes in the way their breasts look or feel.

The hearing also was attended by some opponents of the new guidelines, including Otis Brawley, MD, chief medical officer of the American Cancer Society. Dr. Brawley said the ACS respects the task force but will continue recommending annual mammograms starting at age 40.

"It is important that all new medical information is used to empower physicians and their patients when making medical decisions," Rep. Frank Pallone, Jr. (D, N.J.), chair of the House subcommittee said in a statement. "It appears to me that the take-away message from all of this is that more research is needed and that there is already quite a bit of disagreement within the community as to what is best for the patient."

Video of the hearing and text from opening statements are available online (link).

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