Mammograms: American Cancer Society Guidelines

The review of the various clinical trials as reported by OHSU showed that mammography reduced deaths from breast cancer by about 15% in women ages 40-49. They also found that 1904 (range 929-6378) women had to be screened over 10 years to save one life. For women ages 50-59 years, the reduction in deaths was about the same (14%). The number that needed to be screened was 1339 (range 322-7455). In women ages 60-69, the reduction in deaths was 32%, and the number who needed to be screened over 10 years was 377.

What this means is that mammograms are indeed successful in reducing deaths from breast cancer in all age groups, especially women between 60 and 69 years old. But since the actual incidence of breast cancer is less in women ages 40-49, the absolute/actual numbers of lives saved is also less. So you have to screen more women to get the same benefit.

Stated another way, the Task Force agrees that mammography reduces deaths in women ages 40-49. It just doesn’t save enough lives, in their opinion.

The United States Preventative Services Task Force USPSTF issued new guidelines:

1) The Task Force recommends against routine screening for women ages 40-49. Whether to start screening before age 50 should be an individual choice.

2) The Task Force recommends screening every two years for women between ages 50 and 74.

3) The Task Force can’t make any recommendations on whether women ages 75 and over should be screened, because there is not enough evidence upon which they can base a recommendation.

4) There is not enough evidence to make a recommendation about the value of clinical breast examination (a careful breast exam done periodically by a trained medical professional) for women 40 years of age or older

5) There is no evidence that teaching women how to do breast self examination makes an difference, so they recommend against teaching women how to do it

6) There isn’t enough evidence to say anything about the value of digital mammography and MRI screening in women at average risk of breast cancer.

The Task Force recommendations make sense from a purely "collective" standpoint. They save the most money for the most benefit when you weight the cost/benefit analysis. There will be deaths, however. One in every 2000 women between the ages of 40 to 49 will DIE in order to achieve these cost savings. Now that wouldn't be a problem if people are considered to be robots with no feelings and no family and no children left motherless by these deaths. But that is not the case. And there is a real danger that the government and insurers will take these new guidelines as a basis for disallowing insurance payments for these services. Americans have high standards when it comes to our medical care. We want the very best for ourselves and our loved ones. I hope we do not change as a society in this way. Millions of poor and working class women will be subject to these rules with no backup plan. That would be a step in the wrong direction for our society.

Hat Tip At Work, At Play, At Home All Day.