Last week the US Preventive Services Task Force came out with new guidelines for mammography. Simply stated, the new guidelines recommend that:
1. Routine mammography screening start at age 50 instead of 40 (guidelines provided in 2002).
2. Frequency of screening to be reduced to every two years rather than the previously recommended
3. Breast self-examinations are no longer recommended.
4. Clinical breast exams (performed by physicians) only minimally improve outcome in patients who
These guidelines encountered a furious backlash in the media immediately after its publication in the Annals of Internal Medicine from special interest groups, patient groups and politicians with special agendas.
As a practicing physician, women's health advocate and opinion leader in the prevention movement and a healthier America, I welcome the guidelines and would like to share with you my personal and clinical understanding of their meaning.
Guidelines represent recommendations to be used by the medical community, researchers and public health officials to analyze outcome. Guidelines do not necessarily apply to the individual and should be used to guide the physicians and the patient to a well informed position from which individualized decisions should be made.
For those of us who are in primary care, who see patients every day with various questions about choices and options in health care, guidelines serve as resources to provide better patient care.
Guidelines are developed as a result of years of extensive research by intelligent, physicians and researchers who are assigned the task of reviewing the entire scientific literature on a particular topic and to provide unbiased data on a particular subject matter.
To better clarify the situation with mammography:
1. The members of the US Preventive Services Task Force are all doctors, MDs and PhDs who work at academic institutions around the country. They are not government employees. They are not oncologists or radiologists or breast cancer surgeons who may have a biased perception of the realities of breast cancer. The US Preventive Services Task Force spent almost 2 years reviewing all the studies on mammograms, biopsies, treatment, risks and benefits and prevention since the last guidelines were issued in 2002.
2. Dangers of mammography and biopsy are generally overlooked and minimized in our present healthcare system. Marketing of the business of medicine does not include the downside of too much testing and treating associated with millions of yearly mammograms, biopsies, chemotherapies and radiation therapies. Rarely if ever does a woman get informed of the risks of mammograms and biopsies in the mainstream media, from cancer groups, radiology clinics or academic center physician groups which specialize in the diagnosis and treatment of breast cancer.
- The potential dangers of mammograms occur from too much radiation to the most radiosensitive tissue of the body which does increase breast cancer risk as more mammograms are given to women over extended periods of time
- False positive mammograms prompt unnecessary procedures, fears and treatments which include biopsies, chemotherapy and radiation for often precancerous lesions or slow growing cancers which do not warrant treatment. These procedures carry risks of their own rarely addressed.
- Biopsies disturb breast architecture and body immunity preventing the body from healing itself which scientific data support as a safe and previously unaddressed option.
- Emotional stress caused by all of the above and the fear of cancer increases risk of cancer.
Women are scared to death by the prospect of being diagnosed with breast cancer. In our society women have been taught to believe that the sooner they are diagnosed and the cancer is removed, the better their chances for survival. That is not always true. Deciding to delay treatment or not have mammograms is met with disapproval by conventional physicians even if there is no scientific basis for pushing the patient into mammograms and biopsies.
The Task Force has taken the first significant step toward cutting down cost of healthcare and helping the economy. This is a major step forward in prevention and the change of the health care paradigm. It cannot and should not be perceived as a personal attack on women. Politics cannot be allowed to taint this immense positive step forward.
I am not against mammograms or biopsies. Women at high risk by virtue of genetic factors, environmental exposure and other factors must be addressed under a different category which only serves to reinforce the importance of the connection between the doctor and the patient and the need for women to take responsibility for their own health.
Self-examinations are important since women need to know how their breasts feel and they are most likely to find the breast mass first. Physician examinations are important but caution has to be exerted that the doctor represents the patient's best interest and is not afraid of malpractice suits. When the physician and the patient are aligned philosophically, women will benefit the most.