Physician group updates mammogram screening guidelines
The American Academy of Family Physicians on Jan 15 released its mammogram recommendations on breast cancer screening, based on evidence summarized by the U.S. Preventive Service Task Force, which updated its mammography guidelines in November.
The task force initially was not in favor of routine mammography screening in women aged 40 to 49 years; the new mammogram guidelines angered many women and doctors who consider breast cancer screening important for early detection of the disease.
In the wake of mammogram controversy, the AAFP now recommends that the mammogram screening for women aged 40 to 49 be individualized, meaning that it should be given to those who are in need instead of giving it to every woman in the age group. For women aged 50 to 74, the academy recommends biennial screening mammography.
The physician group recommends also that doctors should discuss with patients about "the evidence regarding each type of screening test, the risk of breast cancer and individual patient preferences."
The AAFP recognizes the uncertainty about the benefits and harms associated with use of mammogram screening in women age 75 and older, clinical breast examination for women age 40 and older and digital mammography or MRI as screening modalities for breast cancer.
The medical association is against doctors teaching women breast self-examination.
In November, 2009, the U.S. Preventive Service Task Force recommended reduced mammogram screening for breast cancer because its new breast cancer guidelines may minimize the harm derived from the screening, while about 85 percent of benefits are retained.
Mammography is based on x-ray or radiation, which is recognized as a cancer-causing agent by the U.S. National Toxicology Program. While doctors claim that the benefits overweigh the risks, the medical procedure is suspected to cause tens of thousands of breast cancer by itself.
The tool is not effective in saving lives.
Dr. James keen, an epidemiologist at the University of Nebraska and Dr. John Keen have reported in the BioMed Central Journal BMC Med Informatics and Decision Making that in order to save one life over the course of fifteen years, 2970 women must be screened. The American Cancer Society says, however, to save one woman, 465 women need to receive the screening.
The screening over-diagnoses breast cancer, leading to over-treatment.
Karsten Jorgensen at the Nordic Cochrane Centre in Copenhagen reported a study in July 2009 in the British Medical Journal saying that one third of all breast cancers detected will automatically regress on their own.
About 45 million mammogram screenings are performed each year. It is generally believed that the early detection method would reduce mortality and boost survival odds. But some studies have shown that the screening method does not cut death risk.
Laura Esserman, MD, MBA, professor of surgery and radiology, director of the UCSF Carol Franc Buck Breast Care Center and colleagues voiced their concern about the use of current mammogram screening for the detection of breast cancer in the journal of the American Medical Association.
Dr. Esserman and colleagues said the method leads to increased detection of early stage or non-life-threatening tumors, but does not reduce the risk of death in patients with aggressive breast cancer.
Mammograms cause cancer.
According to Dr. Samuel S. Epstein, professor emeritus of Environmental and Occupational Medicine at the University of Illinois School of Public Health and Chairman of the Cancer Prevention Coalition, postmenopausal women who undergo annual screening for a ten-year period would receive exposure to about 10 rads per breast.
Dr. Epstein says each rad results in one cancer patient in every 100 premenstrual women. Exposure to 10 rads of mammogram radiation means the risk of getting breast cancer due to radiation is 10 percent. Even worse, breast cancer risk from mammography is fourfold higher for women who carry the A-T gene. Breast cancer of this sort accounts for 20 percent of all breast cancers annually in the United States.
Other risks associated with screening mammography include breast compression, which raises risk of spreading the cancer, particularly in postmenopausal women.
Reporting by Jimmy Downs and editing by Rachel Stockton