The U.S. Preventive Services Task Force (USPSTF) just released a new breast cancer mammography screening recommendation. It advised that mammography should start at age 40, though the report nowhere mentions this new start. The Task Force’s full report is appended below.
Here are some direct quotations from the report which presumably contain the evidence for the new recommendation:
The evidence was insufficient for addressing the age to start or end screening. No eligible studies comparing different ages to start screening were identified.
Evidence was also insufficient for evaluating the effect of screening intervals on breast cancer morbidity and mortality.
Evidence comparing the effectiveness of different breast cancer screening strategies is inconclusive because key studies have not yet been completed and few studies have reported the stage shift or mortality outcomes necessary to assess relative benefits.
With all the uncertainty contained in the report, the obvious question is why the need for a new recommendation to move the initiation age of screening mammography to a decade earlier? The answer is obvious. The various professional organizations that have cancer, especially breast cancer, as their focus have been lobbying for this change for a long time. Accordingly, the USPSTF has caved and made the recommendation their professional constituency wanted. I guess they assumed that no one would read their report. It’s dense and a slog to get through it.
If you would understand the emotional content of this issue just consider the reaction to the recommendation by Dr. Michelle Specht, a breast surgeon and co-director of the Avon Comprehensive Breast Evaluation Center at Mass General Cancer Center. She is “thrilled” that the USPSTF has finalized its recommendations for earlier screenings even though the Task Force presents no data to support its new recommendation. This is the reaction of a partisan, not a scientist.
Mammography has been an emotionally charged issue since its inception. It’s so firmly ingrained in both the professional and public perceptions of reducing mortality from a feared disease that impartial analysis of reliable data has become almost impossible. Any physician who takes a contrary view of mammography is headed for an early retirement or worse.
