What do the New Mammography Guidelines Really Say?

You’ve read about them and heard about them and talked about them to your office colleagues. But what are the new standards presented b the U.S. Preventive Services Task Force ( USPSTF)?

The guidelines are published in the Annals of Internal Medicine and you can read the entire manuscript there.

Some highlights of the paper. The recommendations are simple. They are:

The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older.

The USPSTF recommends against clinicians teaching women how to perform breast self-examination.

The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer.

Task force members maintain that research supports mammogram screening for women over 50, but not for women 40-49:

There is convincing evidence that screening with film mammography reduces breast cancer mortality, with a greater absolute reduction for women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is among women aged 60 to 69 years.

Notice that they mention film mammography. That is an outdated method. Digital mammograms are offered at most—if not all—breast cancer centers. They are more precise and more effective in finding cancers in younger women. In reference to digital mammos, task force members say, in research-ese, that evidence is lacking.

As for breast self exams, the write:

Adequate evidence suggests that teaching BSE does not reduce breast cancer mortality.

I am looking for research on self-exams. My question: Are they studied all that much? If no absolute evidence exists, is that because the subject has not been adequately studied? I will post what I find.

The task force also worried about the harm caused by mammograms and self-exams, although they say these harms are small or moderate.

All in all, not that convincing a case, and a seriously confusing presentation. Shame on them for taking women’s health concerns so lightly that they didn’t think this through better.