In a recent statement, the National Consortium of Breast Centers (NCBC) asked for the USPSTF to rescind its new guidelines. The controversy was an important topic at the NCBC Conference in March. In a preliminary session, Dr. Cady presented a critical assessment of the recommendations, noting that the panel concentrated on models rather than empirical data as evidence for their results.

"The Task Force looked at only the landmark trials but somewhat misinterpreted them and based much of their conclusions on modeling," says Dr. Cady. "Their own data, their own models indicated that they were not selecting the best option for mortality reduction."


According to Dr. Cady, the USPSTF did not account for the inherent compliance and contamination bias of prospective randomized population trials, where women are merely offered screening without commitment. Such trials indicate reductions of 15 to 40 percent of breast cancer mortality. However, results of retrospective studies, where women are actually screened, demonstrate significant reductions of at least 50 percent.

"They judged harms versus benefits. They based harms on women actually being screened. They based benefits on the trials, in which case the benefits were understated by at least 50 to 100 percent," says Dr. Cady.

Other criticisms of the Task Force's methodology include an alleged focus on financial savings rather than reduction of mortality, a lack of breast imaging experts on the panel and reliance on limited information as a basis for conclusions.

"The data are overwhelming that screening reduces mortality, and the more frequently you screen, the more the reduced mortality," says Dr. Cady. "It doesn't happen to fit their definition of 'evidence based.' When people tried to get other data to them, they refused it and wouldn't listen to anything else," he says.

Many breast imaging experts also believe that the Task Force wrongly assessed the psychological discomforts associated with false-positives. Dr. Megan Baker Ruppel is the medical director of the Comprehensive Breast Care Hollings Cancer Center at the Medical University of South Carolina.

"The studies upon which these new recommendations were based demonstrated a significant mortality risk reduction when starting mammograms at age 40," she says. "This is to be balanced by the potential harms, but the emphasis the Task Force placed on 'the anxiety' and psychosocial issues are not appropriate. To focus on this they would have needed to also focus on the psychosocial effects of omission of testing when you want to begin screening mammography at age 50," she says.

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