The U.S. Preventive Services Task Force (USPSTF), part of the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, has just released new guidelines that have stunned the industry as these guidelines are significantly different from the standards that have been recommended by groups such as the American Cancer Society.

First, the USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The agency says any decision to commence regular, biennial screening mammography before the age of 50 years should be an individual decision and take patient context into account, "including the patient's values regarding specific benefits and harms." The USPSTF gives a "C" grade to this recommendation, meaning there is at least moderate certainty that the net benefit is small.

Next, the USPSTF recommends biennial screening mammography for women aged 50 to 74 years. This has a "B" grade for recommended service, meaning there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

Next, the USPSTF reports it has concluded that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. This recommendation has the grade of an "I Statement". An I Statement means that the USPSTF has concluded that the current evidence is insufficient to assess the balance of benefits and harms of the service. The evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

The USPSTF has also recommended against teaching breast self-examination (BSE). This recommendation has a grade "D." For grade D, the USPSTF recommendation against the service is because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. In its Clinical Summary, the USPSTF says "Adequate evidence suggests that BSE does not reduce breast cancer mortality," and has harms including "false-positive results, which lead to anxiety, unnecessary visits, imaging, and biopsies."

Further, the USPSTF has concluded that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. This recommendation also has an I Statement. In the Clinical Summary, the USPSTF says this procedure has the same harms as BSE.

Finally, the USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer. This recommendation also has a grade of an I Statement. In the Clinical Summary, the USPSTF says digital mammography and MRIs are more expensive, and that MRIs yield more false positives than mammography.

American Cancer Society Weighs In

The American Cancer Society released a statement in response to the new USPSTF guidelines, with Otis W. Brawley, M.D., chief medical officer, American Cancer Society stating, "The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions."

Dr. Brawley went on to say, "With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them. The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening. The most recent data show us that approximately 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s, and 22 percent occurred in women diagnosed in their 50s. Breast cancer is a serious health problem facing adult women, and mammography is part of our solution beginning at age 40 for average risk women."

American College of Radiology Concerns

The American College of Radiology (ACR) has also expressed deep concerns over the guidelines. "These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives--including in women aged 40-49. These new recommendations seem to reflect a conscious decision to ration care. If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women," said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission, on the ACR website.

Read More About It

The Guidelines can be accessed at: http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

The Clinical Summary can be accessed at: http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcansum.htm

The American Cancer Society's response can be accessed at: http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Responds_to_Changes_to_USPSTF_Mammography_Guidelines.asp

The ACR's statements can be accessed at: http://www.acr.org/MainMenuCategories/media_room/FeaturedCategories/PressReleases/USPSTFMammoRecs.aspx