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Chapel Hill, NC - The
US Preventive Services Task Force's (USPSTF) recommendations regarding breast
cancer screening have touched off a heated national debate. Lost in
this tumult is one critical recommendation that everyone agrees upon: average
risk women aged 50-74 years old should get regular breast cancer screening
with mammography. In addition, women aged 40-49 years who are at higher
than average risk (due to genetic factors, family history or medical history) should
continue to get regular screening. No matter where this breast cancer
screening discussion takes us, we should not lose sight of this.
Of course, this doesn’t help women aged 40-49 years who are caught in the
middle of this evidence cross-fire. One expert group says this, another
says that. What will my insurance company pay for? What should
I do?
Clinicians are also caught in the middle. Where do I stand? Which
experts do I believe? What should I tell my patients and their families
when they ask?
The USPSTF, the American Cancer Society, and other expert groups have put
forth recommendations they believe are based on a comprehensive and fair review
of the existing evidence. They have reached different conclusions. A
national debate has begun and it seems that everyone is being asked to take sides. Rather
than rush to judgment, what's needed is a careful airing out of the issues and
evidence. UNC, with experts like Dr. Etta Pisano (a radiologist who led
development of digital mammography), Dr. Russell Harris (an expert on cancer
screening), Dr. Michael Pignone (an expert in patient/physician decision-making),
and an outstanding breast cancer clinical team (led by Dr. Lisa Carey, Dr. David
Ollila, and Dr. Larry Marks) has the expertise and experience to help mold this
debate.
In the meantime, what do we do? Along with expert consensus, it seems that
clarity has evaporated. But, has it? We should ask ourselves whether
the breast cancer screening landscape changed so much as to be totally unrecognizable. The
answer is "no."
The USPSTF's new recommendation is against routine screening, not screening altogether. They
recommend that women aged 40-49 years and their physicians should decide when
screening should start after taking into account how each individual feels about
the benefits and harms of screening. For women in this age group and for
those who support the USPSTF, breast cancer screening mammography remains an
important option -- just not a hard and fast standard.
The fear, of course, is that younger women will now hear a mixed message and
decide against mammography -- not only in their 40's but in their 50's and beyond. There
is also worry that third party payers may now use this recommendation as an excuse
for not paying for this screening test. These are important worries that
must be addressed as we move forward.
For now, until we have fully examined and weighed the USPSTF's challenge to the
status quo, the prudent action seems to be to continue to look to current guidelines. Whatever
happens, women aged 50-74 should continue to get regular breast cancer screening
and breast cancer screening should continue to be a choice for women aged 40-49.
Whatever happens, UNC will have the expertise and experience to help.
Shelley Earp, MD
Director |
Michael O’Malley, PhD
Associate Director |
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