Why Can't The Experts Agree On Mammograms? And What Should You Do?
(CBS4) -Here we go again. The same group that triggered uproar -- and a lot of anger -- in 2009 with its recommendations on mammograms has re-issued its guidelines. And those guidelines once again spell concern and confusion for women and their doctors.
In sum: No routine mammograms in women ages 40-49. The group is the U.S Preventive Medicine Task Force, and they say, as they did in 2009, that screening mammography should begin at age 50, and take place every other year (up until age 74).
The Task Force says they have three reasons:
Mammograms do not save lives in women who begin routine screening at age 40. Their analysis of research says so.
Mammograms may result in false positive tests, leading to more tests, more biopsies, and unnecessary worry.
Mammograms may cause over-treatment, if they show a cancer that could be simply observed through watchful waiting without mastectomy, lumpectomy, and other treatment.
So why are these recommendations so important? Mainly because many government programs as well as insurance companies use the Task Force guidelines to determine payment for a test or procedure. Meaning, no coverage, no test.
Interestingly, politicians in our nation's capital have already weighed in, and said that insurers will not be allowed to deny mammograms based on these guidelines. However, the group does have scientific clout, using a term that you will hear more and more of: "Evidence –based medicine." That means, the group does a major analysis of all of the research to date on the subject, then reaches a conclusion about whether a treatment or test is worthwhile. Evidence based medicine gives letter grades, just like schoolwork.
A "no-question everyone should be doing this "grade is an "A". The Task Force has given screening mammography in younger women a "C." In the world of medicine, that's close to failing, and pretty much a "no-go."
If you look at other groups, well, they have somewhat different opinions. The American College of OB/GYN says women should begin annual screening at age 40. The American Cancer Society says annual beginning at age 45. A majority of other groups lean towards the age 40 mark to start. In other words, the Task Force seems to be in the minority at this point, especially in the court of women's health.
So where is this all heading? The major groups will all meet behind closed doors at the end of January and try to hash things out and come up with some kind of consensus. About time, I'd say.
As for you, it remains a personal decision … and one that you and your doctor can work on together. As for me, I'm an advocate of age 40. But I always want my patients to understand that mammography is not perfect. There's a chance it could be falsely positive, and so forth. But nonetheless, I think it's important that you know the facts as we know them, and make the decision that you want to make.
That's an "A" in my real world of evidence-based medicine. I want what is best for you.
Dr. Dave Hnida is CBS4's Medical Editor. He blogs about the latest studies and trends in the health world. Read his latest blog entries, check out his bio or follow him on Twitter @drdavehnida
