The new U.S. Preventive Services Task Force’s recommendations on screening mammography, clinical breast exam, and self-examination conflict with the facts.  There has been no new evidence to justify this questionable change in breast cancer screening guidelines.

Gail Lebovic, MD; Stephen A. Feig, MD: Julio A. Ibarra, MD; Robert W. Carlson, MD

The American Society of Breast Disease continues to recommend annual mammography for all women beginning at age 40.  This position is based on long-standing, evidence-based studies which documents that mammography saves lives through early detection.

The fact that only 50% of American women over age 40 have had a mammogram in the past year indicates that women need to be further encouraged rather than discouraged from obtaining this simple, non-invasive test. At a time of limited healthcare resources, prevention and early detection continue to be the most cost-effective means to control the economic and human burden of breast cancer. Although it is not perfect, mammography is the best screening tool we have, in terms of overall accuracy, cost, and practicality.

Forty years of research have yielded progressively convincing evidence of the benefits of screening mammography.  Long-term follow-up of randomized controlled population-based screening trials – the gold standard in medical research – prove that mammography can reduce breast cancer mortality as much as 32% among women ages 40 to 70 years at entry into screening.  Some recent studies from Sweden have found that mammography can lower breast cancer deaths by nearly 50%.

As dedicated breast specialists, we agree with the multiple studies that document a reduction in breast cancer deaths due to early detection of breast cancer through regular screening. In contrast to the USPSTF recommendations, the American Society of Breast Disease continues to encourage monthly breast self-examination as an integral part of every woman’s health routine, along with an annual clinical breast examination by a trained healthcare professional.

For most women, predicting breast cancer risk on the basis of possible risk factors can be unreliable.    Fully 70% of all women diagnosed with breast cancer had no known risk before the time of diagnosis.

The current flurry of media-hyped recommendations will only serve to confuse the public. To advise women age 40 and older to skip annual screening because they have no family history of the disease, is imprudent, irresponsible, and places their lives at unnecessary jeopardy.

About the Authors: The authors are officers of the American Society of Breast Disease.  Gail Lebovic, MD, is a Dallas-based oncoplastic breast surgeon and Society president; Stephen A. Feig, MD, is a breast imager at University of California, Irvine, and president-elect; Julio A. Ibarra, MD, is a pathologist at MemorialCare Hospital, Fountain Valley, California, and Society past president; and Robert W. Carlson, MD, is a medical oncologist at Stanford University and Society secretary/treasurer.

About the American Society of Breast Disease: The ASBD is a nonprofit medical society that endorses and promotes integrated multidisciplinary breast care to optimize patient outcomes.  To learn more about the Society and its programs, visit www.asbd.org

Copyright © 2009 American Society of Breast Disease.  All rights reserved.