Earlier this week the U.S. Preventive Services Task Force (USPSTF) issued revised breast cancer screening guidelines: women in their 40s who have no unusual risk factors for breast cancer should not receive routine mammograms for early detection of breast cancer and should instead begin routine screening at age 50.
This is proving upsetting especially to women who were diagnosed with breast cancer at a young age, which is understandable. At the same time, I can't help but wonder…is routine mammography for women in their 40s who have no risk factors for breast cancer akin to continuous electronic fetal heart rate monitoring (EFM) for all women with low risk pregnancies?
Fetal heart rate monitoring during labor is essential, but continuous EFM may send up red flags where none are needed. EFM readings vary by machine and clinician. Jump on an abnormal reading too quickly and you may end up with an unnecessary cesarean section—major abdominal surgery that carries heightened risks for both mother and baby.
In fact, ACOG recently revised their EFM guidelines and put it into perspective in a press release containing this insightful statement:
“Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002," says George A. Macones, MD, who headed the development of the ACOG document. "Although EFM is the most common obstetric procedure today, unfortunately it hasn't reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions."So, what about these revised breast cancer screening guidelines? Here’s a snapshot of the National Breast Cancer Coalition (NBCC) analysis of the revisions :
“Mammography can miss cancers that need treatment, and in some cases find disease that does not need treatment, leading to overtreatment with toxic therapies. Harms for healthy women who do not have cancer can include unnecessary imaging tests and biopsies, unnecessary exposure to x-ray radiation, and psychological trauma and anxiety.”and…
“All breast cancers are not equal. Some patients will have fast-growing, aggressive tumors while others will have slower-growing, less aggressive tumors that are less likely to metastasize and, therefore, have a better prognosis. Screening is more likely to identify the slower-growing, less aggressive tumors because of longer asymptomatic periods. This “length-time” bias can make screening appear more beneficial than it is.”Notice any similarities to continuous EFM?
What do you think? Are these revised guidelines a step toward backing off of our nation’s overuse of technology and interventions? Or was this a bad public health move?
