New Recommendations by the U.S. Preventive Services Task Force (USPSTF) Regarding Screening Mammography

The U.S. Preventive Services Task Force (USPSTF) has made significant changes for recommendations for breast cancer screening. They now recommend:

No routine screening for women aged 40 - 49
No breast self-exams
No clinical breast exams
No annual screening for women aged 50 - 74, rather they recommend screening every two years.
No screening for women aged 75 years and older

The scientific reasons for these recommendations are unclear. Since mammography screening became widespread, there has been a drop in the breast cancer death rate by 30 percent since 1990. Prior to the onset of screening, it had been stable for the past 50 years. In countries where screening is uniformly done, such as Sweden, the drop in death rate has been more dramatic, approaching 40 percent. Why has the U.S. Preventive Services Task Force adopted these recommendations?

They seem overly concerned about the "harms" from mammography, including the discomfort, the anxiety from recall, and needle biopsies of the breast. These anxieties are minor compared to finding out that your breast cancer has been growing for the past two years, and now has spread to the lymph nodes under the arm and beyond in the body.
They estimate mortality reduction to be 15 percent, both in women 40 - 49 and 50 - 59. Yet, because cancer is less frequent in women 40 - 49, they say the harms are too great to justify screening. This ignores the fact that the earlier cancer is detected, the better chance there is to save a life.
They have used different mathematical models that do not agree with each other. Actual randomized clinical trials have all shown a major benefit to screening except for the Canadian National Breast Screening Trial, which has serious flaws.
There is no new data that they have considered. Rather, they have selectively taken old data, ignoring data that do not fit with their recommendations, such as the Swedish trials.
They have not acknowledged that randomized clinical trials always underestimate the benefits. See the Clinical Trials page for more information about randomized clinical trials.

Most of the medical community disagrees with their recommendations. The following are links to recommendations from the American College of Radiology, Society of Breast Imaging, and a more complete analysis of the USPSTF recommendations:

The U.S. Department of Health and Human Services Secretary Kathleen Sebelius issued a statement in response to the revised USPSTF recommendations:

"There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country.

My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you."

To read the entire statement, visit the U.S. Department of Health and Human Services Web site.