Mammogram Task Forces Goes before Congress

(CBS)  Sticking carefully to the script, the lead doctors behind the controversial new mammogram recommendations issued a mea culpa, saying they "communicated very poorly."

But for many lawmakers, it wasn't just the communication that fell short, reports CBS News correspondent Nancy Cordes.

"To me it's sending the wrong message to women. It's saying you don't have to be vigilant, you don't have to take care of yourself," said Rep. Sue Myrick, R-N.C.

Still, the government-appointed task force is holding firm on its recommendation that most women should not get regular mammograms until the age of 50.

"Mammograms over 40 should not be automatic," said Dr. Diana Petitti, a co-author of the study.

Many doctors are ignoring that advice, recommending that patients are screened annually.

"Is there anything that this panel could say that would convince you that women should wait until after 50 to get mammograms?" Cordes asked Dr. Mark Reiter.

"It would be very difficult," Reiter said. "I think they should listen to the women under 50 who have been diagnosed with breast cancer due to the virtue of the mammograms."

The task force leaders said Wednesday they were swayed by the frequency of false positives among younger women, which can lead to stress and unnecessary surgery.

They were pressed to explain another controversial recommendation regarding breast self-exams.

"The task force recommended against clinicians teaching women breast self examination. They did not recommend that women not pay attention to their bodies," Petitti said.

"Well, how are women to get that knowledge?" Rep. Michael Burgess, R-Texas asked. "They can't just get it by intuition!"

Lawmakers and doctors worry that insurance companies will use the guidelines to justify reductions in mammogram coverage.

"Wait until that insurance company comes out and says 'Well we based it on this task force, a government task force recommendation says I don't have to pay for mammography for a woman ages 40-49,'" said Rep. Michael Rogers, R-Mich.

The task force insists its guidelines have been misconstrued to mean that women under 50 should forgo mammograms altogether. They say they meant to convey that women under 50 should consult with their doctor to make the choice that's right for them.

[koshechka-2009]

As someone who's been following the discussions of mammography in medical journals and read the studies - because I was interested, not for professional reasons - I was not at all surprised by these recommendations. For years this issue of mammograms for younger women have been discussed with different organizations having different recommendations. This is just a new twist and IMHO it is long overdue. For years we women were told that every cancer found on the mammogram represent live saved when in fact it's only a small percentage of cancers; we were told benefits expressed in meaningless relative risk reduction numbers instead of more useful absolute risk reduction or Number Needed to Screen, we were told that mammograms and pap smears are risk free, and that everyone needs to get screened. What we weren't told is that
- one needs to screen 1890 women in their 40s for 10 years (1300 women in their 50s, 385 in their 600s) to prevent one death from breast cancer
- that for every woman whose life is saved by mammograms 10 women will get an unnecessary diagnosis of breast cancer - this is called "overdiagnosis", look it up. - http://www.cochrane.dk/
- that during the same period several hundreds women (Cochrane says it's around 10%, but the US numbers are higher - 20-50%) will get at least one false positive, forth of which would result in biopsy.

Overdiagnosis is a problem for all women, not just younger women, but there are more false positives in 40-something group and less real breast cancer. Also the breasts of younger women are denser and more susceptible to radiation. Now, radiation is small, but it's cumulative especially if you consider all false positives.

This decision of USPSTF came less than a month after some additional data that showed that the mortality reduction in mammograms is even smaller than it was thought and the overdiagnosis is even greater.

In terms of pap smears: this is a rare cancer even before pap smears; so one needs to screen a lot of women (I read a number of 1000 for 35 years, but I am not sure if this one is correct) to prevent one case of cancer. But during the same time more than half of the women will have a colposcopy, many of them will get LEEP result, some of the treatment for this "precancers" may have detrimental effect for their fertility. Many of these early leisions disappear on their own, especially in young women and the cancer itself is slow-growing. Hence the change in recommendations. Less frequent screening gives an opportunity for some of those leisions to disappear and reduces overdiagnosis.

Screening has both benefits and risks. It benefits very few people - tremendously - but it also harms a few healthy people. The panel's recommendations are based on the analysis of benefits and harms.

@mammographer -- this is what you collegue has to say about it. http://www.imagingeconomics.com/issues/articles/2004-11_02.asp?SkipInterstitial=TRUE I especially like "The knowledge gap" section. Don't you think we women have a RIGHT to this information? You talk about lives saved, but you conveniently forget to mention lives harmed - all these women who could've lived their whole lives without cancer diagnosis yet who suffered the side effects of the treatment?

[kittykitty7555]

koshechka-2009, thank goodness that there are people like you who know the facts about screening mammo and are willing to post them. Women have been lied to for so many years that they don'e even believe that "overdiagnosis" is even possible - yet it is clear as day that screening mammography results in the unnecessary diagnosis of breast cancer (just like the PSA test results in the unnecessary diagnosis of prostate cancer). Please see:

http://www.cochrane.org/reviews/en/ab001877.html

and:

Please see http://www.bmj.com/cgi/content/abstract/339/jul09_1/b2587?ijKey=7e6790d5a0e2891bed39b29ee855a26d8f4125bb&keytype2=tf_ipsecsha

The point of this research is that mammography finds harmless lesions that look like cancer (even under a microscope), but are meaningless. This leads women to get cancer treatment that they don?t need. Women routinely get all or part of a breast removed, get radiation that can cause lung cancer and deadly heart problems, and receive toxic chemotherapy ALL FOR NOTHING. This happens in 1 of 3 cases of ?breast cancer? that are identified via mammography screening. These women are all told how lucky they are, when in reality if they hadn?t been screened they would have never had breast cancer at all. Hard to believe, but it?s true.

In the United States, there is a huge propaganda machine that bullies and pushes women into mammography without informing them of the risks. Instead women are told that if they get screened maybe they won?t need a mastectomy, but just a little tiny operation. However, women who are screened via mammography are about 30% more likely to have the entire breast cut off than women who refuse screening. Yet we never hear about this.

This has got to stop! Women should be informed about the risks of screening mammo - and the risks are HUGE. Routine mammography is a major risk factor for getting a cancer diagnosis, and women need to wake up to this fact! We have been lied to by the cancer industry for too long. And those screaming the loudest about the new guidelines are the ones whose incomes may drop if women forgo the yearly irradiation of their breasts. Keep that in mind when you are deciding who to believe about screening mammography.

[Ellecs]

@lffitts2: "...science says that screenings don't save lives...don't like it OK... but that is the science."

Actually, the "science" says mammograms do save lives. According to, "Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force", "Conclusion: Mammography screening reduces breast cancer mortality for women aged 39 to 69; data are insufficient for older women." Screening for women 39-49 years reduces breast cancer deaths by 15%; screening for women in their 50s reduced breast cancer deaths by 14%. (These are USPSTF numbers.) As mentioned, the data for older women was insufficient, yet the task force chose to make a recommendation about ending screening at age 74 without the "science" to back it up.

The spin we've been given is that the new recommendation will maintain 81% of the benefit and reduce harms by almost 50%. Translation- By performing half as many mammograms, there will be almost half as many false-positives and unnecessary biopsies, but deaths from breast cancer will increase by 19%.

So, even though "science" found that annual mammography screening was the most effective (i.e. saved the most lives), "science" also found that biennial screening "had a higher cost-effectiveness ratio." (see "Contextual Question: What is the cost-effectiveness of screening?" in "Screening for Breast Cancer: Systematic Evidence Review Update for the U.S. Preventive Services Task Force.)

It's not the science I mind- it's placing "cost-effectiveness" above a woman's life that bothers me.

[weewillywonka]

They can hardly blame women for being suspicious. All of a sudden 2 of the tests (mammograms, and pap tests) women have been told for years are critical to their good health - are all of a sudden not so important. Reminds me of all the years that birth-control was not covered by insurance --- until insurance started covering mens erectile-dysfuntion. Women went ballistic then too.

[sean56v]

Treatment of aggressive breast cancer is a lucrative business. The Task Force protects their financial investment. Unethical physicians fleece the American Public with poor advice.

[excop1949]

Better to beg forgiveness than ask permission...?

[RegVoter]

There is no such thing as the "Mammogram Task Force." It is the "U.S. Preventive Services Task Force" established in 1984. Why these serious medical professionals should be treated this way by congress and contine to participate on the task force is a mystery to me.

[lfitts2]

Please read the opinion above in this site..the point is you can drag in any number of people for anything that state" my life was saved by..". Medicine is SUPPOSED to be science based..science says that the screenings don't save lives..don't like it OK..but that is the science. Meanwhile these same stupid Republican reps are trying to limit and prevent women from controlling their bodies..and they are the champions of womens rights..better search for others..these are wolves in sheeps clothing

[gnimelf1968]

It's not the republicans, the democrats are the ones that want to get rid of people and lower the population.

[mammographer]

Medical science is based on randomized clinical trials. Medical science has shown that screening mammography, even in the age group 40 to 50 is effective (though not as effective as we would hope for). The task force based their recommendations on computer models and 'effective frontier plots'. That is based on economic theory, and concludes that there is only a small percentage reduction in breast cancer mortality by doing annual screening beginning at age forty as opposed to biennial screening at age 50. That is an analysis typically performed by the Congressional Budget Office, not medical professionals. The 'small percentage' of more lives saved translates to 1000's of lives saved on an anual basis in the United States.

[JackieEL]

Where did they find these STUPID PEOPLE to be on this task force. As a breast cancer survivor believe me my mamo saved my life and my daughters will get their mamos before the age of 50. Are they trying to go backwards after there have been so many strides to save the people that are strickened by this terrible disease? I can not believe any woman on this panel can sit there and go along with these terrible suggestions. If this makes my insurance company not pay for a yearly mamo I will still get one and send the bill to these STUPID, UNEDUCATED PEOPLE.

[koshechka-2009]

How do you know that in your case mammogram saved your life? Some cancers grow so slow that they are still curable when detected later. Some cancers don't progress at all, most cases of DCIS never progress, but even some locally invasive cancers don't progress in woman's lifetime. In fact, mammograms make a difference in one specific case: cancers that grow sufficiently slow for mammogram to discover them before they spread yet fast enough to spread before you notice the tumor. The science today cannot say which is which. Yet, you think you can? Do you have a crystal ball? According to Cochrane review for every 1 woman whose life is saved by mammograms 10 get unnecessary diagnosis of breast cancer. Yet you are sure you are this one?