New breast cancer screening guidelines by the Canadian Task Force on Preventive Health, which recommend against annual screening of women ages 40-49 and extending time between screens for older women, ignore results of landmark randomized control trials. These trials show that regular screening significantly reduces breast cancer deaths in these women.
While implementation of the guidelines may save money each year on screening costs, the result will be thousands of unnecessary breast cancer deaths. Hellquist et al and Tabar et al, respectively, the largest and perhaps longest breast cancer screening trials ever performed, proved regular mammograms reduced breast cancer deaths by about a third – even in women 40-49.
“Less screening equals more deaths, more extensive treatments and higher costs to treat advanced cancers. The issuing of such guidelines by panels with little or no demonstrated expertise in the care on which they are rendering recommendations is problematic.
Their recommendations can directly affect availability of care. They can also cause providers to mistakenly suggest to patients plans of care that ultimately result in unnecessary deaths.” – Barbara Monsees MD chair American College of Radiology Breast Imaging Commission The Canadian guidelines, which will be published in the Canadian Medical Association Journal (CMAJ), reflect those released by the United States Preventative Services Task Force (USPSTF) in 2009.
The USPSTF approach misses 75 percent of cancers in women 40-49 and up to a third of cancers in women 50-74. An analysis (Hendrick and Helvie) in the American Journal of Roentgenology, showed that, if USPSTF recommendations were followed, 6,500 additional women each year in the U.S. would die from breast cancer.
A similar proportion of Canadian women will likely die unnecessarily each year from breast cancer if the guidelines are followed. “Particularly, when paired with the now debunked USPSTF recommendations, the Canadian guidelines may significantly impact the ability of women to get a mammogram in their community and turn back the clock on tremendous gains made against breast cancer over the last two decades,” said Dr. Monsees.
According to National Cancer Institute data, since mammography screening became widespread in the early 1990’s, the U.S. breast cancer death rate has remained unchanged for the previous 50 years. It has dropped well over 30 percent.
Every major medical organization with expertise in breast cancer care, including the American Congress of Obstetricians and Gynecologists (ACOG), American Cancer Society, American College of Radiology, and Society of Breast Imaging continue to recommend that women begin receiving annual mammograms at age 40.