EWBC Response to USPSTF Mammography Guidelines
Posted on: 12/23/2009
Confusion has surfaced in the wake of the recently published US task force guidelines in the Annals of Internal Medicine. We at Elizabeth Wende Breast Care, LLC wish to clarify our stand on these issues, given our center’s 30 years of experience in the field of breast imaging and intervention.
Radiologists, oncologists and other medical providers are aware of the limitations of mammography. However, there are life-saving benefits that women receive from this screening tool that the US task force seems to have ignored. Several multi-institutional trials, both in the U.S. and internationally, have documented that screening mammography saves lives. Since routine mammography began in 1990, the number of deaths from breast cancer has decreased by 30%. One of the largest screening trials to date, the Digital Imaging Screening Trial (DMIST) published in the New England Journal of Medicine in September, 2005, showed life saving benefits from screening digital mammography. In particular, digital mammograms identify more cancers in women who have dense breasts, women under age 50 and in peri-menopausal women. In addition, this trial also demonstrated that call back rates and false positive rates have decreased with the newer technologies that are now available. One must note that film-screen mammography also detected significant numbers of cancers in all women. At our breast center, 30-35% of the lives saved by screening mammograms are women aged 40 to 49. This echoes similar numbers in other studies. These studies are based on scientific fact, not fear and faith, as some suggest.
The risks associated with mammography are negligible. The radiation dose is similar to normal background radiation for a year, and with the new digital technology, the dose is even lower than film-screen mammography. Our facility offers patients their results the same day as their mammogram, which helps to relieve anxiety. Additionally, if a biopsy has to be performed, it can usually be performed the same day. The doctor then calls the patient with the results within 24 hours.
The task force tried to say that they wanted to put the “decision making power into women’s hands”, but they actually made more confusion and turmoil. We fear women will think it’s okay to skip their mammograms and clinical breast exams. As experts in the field of breast imaging and diagnosis, we see firsthand what can happen when women delay their preventive health care. When women miss their yearly studies, we see more advanced cancers. When cancer is diagnosed at a later stage, more therapy is required for treatment and the cure rate is decreased.
We recommend women adhere to the American Cancer Society guidelines; routine screening mammograms beginning at age 40. Women at high risk for breast cancer should talk with their health care providers about whether they should begin mammographic screening before age 40. These women may also benefit from other supplemental breast imaging technologies.
Finally, many health care providers palpate and detect cancers that some mammograms cannot detect, especially in women with dense breasts. Yearly clinical breast exams are very important. This is also an opportunity for women to learn how to do a proper self breast exam from a skilled health care provider.
Posy Seifert, D.O.
Patricia Somerville, M.D.
Stamatia Destounis, M.D.
Philip F. Murphy, M.D.
Wende W. Young, M.D.
