Debate over mammograms

New breast cancer screening guidelines have sparked a national debate.

The recent recommendations by the United States Preventative Services Task Force saying most women don't need mammograms in their 40s has spurred a major controversy and created considerable apprehension among women across the nation. Nonetheless, this is a debate worth having.

It is important to note that the recommendations are not a mandate of any kind. They are simply the findings of one government panel and will not dictate protocols for treatment anywhere.

In fact, Health and Human Services Secretary Kathleen Sebelius, issued a statement Wednesday disputing the findings of the panel and reiterating that the task force does not set federal policy. “Indeed,” she said, “I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.

Sebelius said flatly that women should continue getting regular mammograms starting at age 40. That, of course, has been the position of the American Cancer Society for years.

Nonetheless, this is not the first time that recommendation has been challenged by medical researchers. In the latest report, the panel of doctors and scientists concluded that early and frequent mammography screenings often lead to false alarms and unneeded biopsies, without substantially improving women's odds of survival.

In fact, said the panel, the radiation from yearly mammograms could pose a hazard of its own. One estimate is that the cumulative exposure to radiation through mammograms for women aged 40 to 50 could cause as many deaths as are prevented with yearly screening.

The panel even advised against teaching women how to conduct self-exams of their breasts, saying the exams do little to reduce breast cancer mortality.

Women cannot be blamed for reeling from these new recommendations. What women have believed for years to be the orthodoxy for combating breast cancer is turned upside down by the panel's findings.

Most people know of women in their 40s whose breast cancer was detected during an annual screening. Early detection has saved the lives of many women.

But advocates of the task force findings argue that science-based, statistically valid protocols for breast cancer screening are preferable to the emotionally motivated and anecdotal reasons behind the call for early screenings. Younger women, they say, must weigh the real risks along with the benefits of early screenings.

The task force also notes that its recommendations are focused on women at average risk of breast cancer. Women with family or personal history of increased cancer risk might need to begin screening at a younger age.

Unfortunately, however, these conflicting messages are certain to be confusing. The decision regarding when to begin getting regular mammograms is more complicated when the recommendations differ.

It might be helpful to remember, however, that the focus of both the Preventative Services Task Force and the American Cancer Society is to determine the best approach for keeping women healthy. The task force is not advocating less treatment simply to reduce the cost of health care.

And, finally, both organizations are in agreement about one major point: Women should talk with their physicians, ask questions about which approach to take, and make the decision that is right for them.