Among professional organizations, a resounding chorus of disagreement
After publication of the new US Preventive Services Task Force (USPSTF) breast cancer screening guidelines late last year, it was only a matter of hours before official bodies and professional organizations began to weigh in on the changes, and the verdict was unanimous—disagreement. Among those chiming in were the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (ACOG), the American College of Radiology, the American Society of Breast Surgeons, the Society for Breast Imaging (SBI), and Susan G. Komen for the Cure, among others. Here are excerpts from their statements.
American Cancer Society
The ACS immediately refuted the USPSTF recommendations:
The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider….[T]he American Cancer Society’s medical staff and volunteer experts overwhelmingly believe the benefits of screening women aged 40 to 49 outweigh its limitations.7
ACOG
The College reaffirmed its support for screening mammography every 1 to 2 years in women 40 to 49 years old and every year for women 50 and older, as well as breast self-examination for women of all ages:
At this time, The American College of Obstetricians and Gynecologists recommends that Fellows continue to follow current College guidelines for breast cancer screening. Evaluation of the new USPSTF recommendations is under way. Should the College update its guidelines in the future, Fellows would be alerted and such revised guidelines would be published in Obstetrics & Gynecology.5
American College of Radiology
The College minced no words in opposing the changes:
If cost-cutting US Preventive Services Task Force (USPSTF) mammography recommendations are adopted as policy, two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year.
These new recommendations seem to reflect a conscious decision to ration care. If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women,” said Carol H. Lee, MD, chair of the American College of Radiology Breast Imaging Commission.8
American Society of Breast Surgeons
The organization released a statement describing its position as “strongly opposed” to the USPSTF recommendations:
We believe there is sufficient data to support annual mammography screening for women age 40 and older. We also believe the breast cancer survival rate of women between 40 and 50 will improve from the increased use of digital mammographic screening, which is superior to older plain film techniques in detecting breast cancer in that age group.
While we recognize that there will be a number of benign biopsies, we also recognize that mammography is the optimal screening tool for the early diagnosis of breast cancer in terms of cost-effectiveness, practical use, and accuracy.9
Society for Breast Imaging
In its statement, the SBI noted the confusion caused by revision of the USPSTF guidelines, calling it “unnecessary and potentially deadly”:
Mammography has been shown unequivocally to save lives and is primarily responsible for the 30% decline in breast cancer mortality in the United States over the past 20 years. The USPSTF conclusion—that women under age 50 should not undergo routine screening—conflicts with their own report, which confirms a benefit of mammography to women age 40–49 that is statistically significant.
We strongly urge women and their physicians to adhere to the American Cancer Society recommendations of yearly screening beginning at age 40.10
Susan G. Komen for the Cure
This public advocacy group issued a statement in late November acknowledging “mass confusion and justifiable outrage” in the aftermath of the USPSTF changes:
”We have worked so hard to build public trust and urge people to get screened,” said Nancy G. Brinker, founder of Susan G. Komen for the Cure, “and now they hear that maybe they shouldn’t bother. That is dangerous….Let me say this as clearly as I can: Mammography saves lives, even this report says that. Keep doing what you are doing. And always, talk with your doctor.” Brinker also noted that Komen for the Cure was not changing its guidelines, continuing to recommend annual mammograms beginning at age 40.11
3. Why have the guidelines captured so much media attention?
Most of the controversy that has arisen since publication of the new guidelines has centered on the recommendation against screening mammography in women 40 to 49 years old. A number of media outlets have highlighted women whose breast cancer was detected by screening mammography when they were in their 40s, and many survivors with a similar history have spoken out against the new recommendations.