The USPSTF Misses Again on Breast Screening Guidelines
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In a recent move that is drawing much ire from the medical and women’s health communities, the U.S. Preventive Services Task Force (USPSTF) declined to expand its recommendation on which women should receive regular mammography screening. What was offered upon this rejection was essentially the reinforcement of the conservative guidance from 2009.
The new guidance states that women in their 50s should only receive mammography screening every two years, rather than annually as is advocated by many women’s health and medical groups. Advocates for annual screening are also upset that the USPSTF did not recommend screening for women in their 40s, because of its belief that the benefits of screening in this age group do not outweigh the purported harms of screening.
To be blunt—this is questionable advice at best. The guidelines will do nothing but confuse women as again they are not emphatic, but leave decisions up to the women’s general physicians or OB-GYN.
Many women in the 40 to 49 group have dense breasts. Having regular screening mammograms can help this group be sent for further screening with adjuncts such as full breast ultrasound and MRI—helping to find earlier cancers.
Many countries, such as Sweden, Norway, Australia and Canada have adopted the approach that if you have dense breasts (or a certain amount of glandular tissue,) the woman should be screened yearly. Women with fatty breasts are screened every 2 years. This is without arbitrary age grouping.
The U.S. is getting better about dense breast notification, as 22 states have enacted laws about notifying women who possess dense tissue, and a number of other states have bills introduced about these notifications, but these new guidelines from USPTF could hinder this progress.
Breast cancer is heterogenous, i.e. ,many different types with some being much more aggressive than others. Finding cancers later may do more harm as treatments will be ineffective, more toxic and of course more expensive
Another one of the biggest pain-points in the new guidelines was that women over 70 were excluded. This is just not right. Many women in this age group are active, healthy and go on to live very long lives. Finding breast cancer in this age group can be easier due to the fact many women in this age group have fatty breast tissue, making cancer show up much easier. Small cancers can be treated and women can go on to live very productive lives.
On a personal note, two of my aunts had small cancers found when they were over 75. One lived to be 93, being cancer-free for almost 20 years, and the other lived to be 103!
As a woman, I am lucky I have had the opportunity to have advisors and the education to know what to do. There are many out there who are not so lucky. Much has been done to educate women on the importance of screening, and what the USPSTF is doing by confusing them will not help.