Common mammogram self-exams questionable

Women in their 40s should stop routinely having annual mammograms and older women should cut back to one scheduled exam every other year, an influential federal task force has concluded, challenging the use of one of the most common medical tests.

In its first reevaluation of breast cancer screening since 2002, the panel that sets government policy on prevention recommended the radical change, citing evidence that the potential harm to women having annual exams beginning at age 40 outweighs the benefits.

"We're not saying women shouldn't get screened. Screening does saves lives," said Diana Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday's Annals of Internal Medicine. "But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully."

The task force's new guidelines, which also recommend against teaching women to do regular self-exams of their breasts and concludes that there is insufficient evidence to continue routine mammograms beyond age 74, immediately triggered intense debate.

Several patient advocacy groups and many breast cancer experts praised the shift, saying it represents a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

"Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it," said Daniel Kopans, a radiology professor at Harvard Medical School. "It's crazy - unethical, really."

About 39 million women undergo mammograms each year in the United States, costing the health care system more than $5 billion a year.

The new guidelines were based on a comprehensive analysis of the medical literature involving some 70,000 women, new results from a British trial involving more than 160,000 women and data from more than 600,000 women from the U.S. Breast Cancer Surveillance Consortium.

While annual mammography for all women beginning at age 40 reduced the death rate from breast cancer by at least 15 percent, the modeling studies indicated that the added benefit of starting before age 50 was modest, the researchers concluded.

"What isn't in the model but is an issue is how many extra imaging tests are done to follow up on things that turn out to be falsely positive and the harm of the anxiety that goes along with that," Petitti said. "Then there's the whole other line of problems that come into play, which is where there are some breast cancers detected that grow very slowly and would never have killed you."

Cutting back to biannual screening of women age 50 and older would maintain 81 percent of the benefits of screening annually while reducing by half the number of false positives.