New mammogram advice hotly debated

NEW YORK — Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task force said Monday, a major reversal that conflicts with the American Cancer Society’s long-standing position.

Also, the task force said breast self-exams do no good and women shouldn’t be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.

“We’re not saying women shouldn’t get screened. Screening does saves lives,” said Diana Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage for mammograms isn’t likely to change because of the new guidelines.

The guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations that would justify having mammograms sooner or more often.

Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years because of scant evidence of their effectiveness. At one time, the practice was so heavily promoted that organizations distributed cards that could be hung in the shower demonstrating the circular motion women should use to feel for lumps in their breasts.

The task force’s new guidelines immediately triggered intense debate.

Several patient advocacy groups and many breast cancer experts praised the shift, saying it represents a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes disfiguring biopsies, and unneeded treatment, including surgery, radiation and chemotherapy.

The American Cancer Society sharply challenged the new advice.

“This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over,” the cancer society’s chief medical officer, Dr. Otis Brawley, said in a statement.

The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.

That stance “is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them,” he said.

“Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it,” said Daniel Kopans, a radiology professor at Harvard Medical School. “It’s crazy — unethical, really.”

Starting at age 40 would prevent one additional death but also lead to 470 false alarms for every 1,000 women screened. Continuing mammograms through age 79 prevents three additional deaths but raises the number of women treated for breast cancers that would not threaten their lives.

About 39 million women undergo mammograms each year in the United States, costing the health care system more than $5 billion a year. Petitti denied that the panel was influenced by the health care reform debate or cost issues.