New mammography guidelines—now what do I do?

By Alice Yaker

From Executive Director's Blog

Most of us at SHARE are breast or ovarian cancer survivors. Some of us with breast cancer were diagnosed as a result of a suspicious finding on a yearly screening mammogram when we had no symptoms. Others of us, like me at age 48 and then at 66, were diagnosed even though nothing showed on those yearly mammograms.

We have known for a long time that while mammography is the best technology we currently have for screening, it is not without costs. These costs need to be measured against benefits. We each have a story to tell, but quality health care and evidence- based medicine cannot be based on our personal stories. It must be based on the emerging and changing science that comes from good research.

The US Preventive Services Task Force, a reputable and well-respected government-appointed panel of experts that systematically reviews evidence and develops recommendations for clinical preventive services, has just released a new set of guidelines for breast cancer screening, including screening with mammography.  Keep in mind that these guidelines are for screening healthy women with no symptoms, not for high-risk women. They also do not apply to women or men who have found lumps or something suspicious in their breasts and need a mammogram to help diagnose whether they have cancer.

For those of us engaged in breast cancer issues and action, there is little surprise here. The research upon which the changed guidelines is based has been accumulating for many years and has already been presented at many conferences.

The new guidelines and the research upon which they are based support mammography screening for women over the age of 50 since the benefits outweigh the risks. That is not the case for women under 50. The guidelines also support getting a screening mammogram every two years since, based on the research, the benefits for yearly screening are no better than for screening every two years. Keep in mind that the value of screening is to reduce mortality so when the research looks at benefits, it's mortality that is the endpoint.

So how do we all sort this through, especially since we have been told over and over again that we must get screened with mammography at 40 and every year after that for the rest of our lives; that screening with mammography will save our lives?  How do we get past the anecdotes that everyone has about their breast cancer and how it was found? How do we give credibility to the research results that support the need to review and modify clinical practice guidelines so our practitioners use evidence based medicine in their practices?

One of the ways to do this is to now engage your physicians in a conversation about whether screening mammography is right for you: whether the benefits (reduced chance of dying from breast cancer) outweigh the harms of false positives, unnecessary biopsies and excessive radiation, as well as the limitations that may exist for women your age. Dense breasts, for example, mostly found in younger women, could interfere with a diagnosis through mammography.

You can also keep an open and inquiring mind. Look at how other organizations involved with these issues are responding including the National Breast Cancer Coalition, The National Women's Health Network, and the American Cancer Society.

And you can engage SHARE in a conversation to help sort through the issues, your concerns and fears and how to make a decision about your own health. As with all that we do at SHARE, we are available for an ongoing dialogue and look forward to hearing your thoughts and sharing many of them on our website. This is an exciting and critical moment in time for all of us and we look forward to facilitating an important conversation. Please post your comments.

Posted November 17, 2009.