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Do Yearly Mammograms Save Women's Lives?

Controversial new recommendations on breast cancer prevention have caused a stir in the women's health community. But do yearly mammograms really change death rates?
 
 
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EDITOR'S NOTE: Since this article was written, Health and Human Services Secretary Kathleen Sebelius has yielded to the uproargenerated by new guidelines from the U.S. Preventative Services Task Force, and essentially urged women to ignore the committee's recommendations, and continue with their yearly mammograms, and monthly self-examinations.

The new recommendation from the U.S. Preventative Services Task Force that women under 50 should not undergo routine mammography is generating a lot of controversy -- it is a direct challenge to the strong message women have been receiving for two decades that they should have yearly screening starting at age 40. The task force also recommends that women age 50-74 have a mammogram every two years (rather than yearly) and finds that there is little benefit in screening women over 74 at all.

To the experts who have been questioning the benefits of mammography for several years, these recommendations are no surprise -- and they are welcome. The World Health Organization, and many European countries where the government pays for routine mammography screening, already follow these guidelines. But how is this news playing in Peoria?

The initial reaction from many health professionals, breast cancer survivors and advocates has been outrage and anger, with many insisting that women's health will be compromised if these recommendations are implemented. Still others see the new guidelines as evidence that the government is using comparative-effectiveness studies to justify rationing care. Leading this onslaught are some key members of the cancer establishment: The American Cancer Society, The American College of Radiology and the National Cancer Institute.

Dr. Otis W. Brawley, chief medical officer of the ACS, released this statement in response to the Preventative Task Force report: "As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: this is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member."

Dr. Carol H. Lee, chair of the American College of Radiology Breast Imaging Commission, launched a blistering attack on the Preventative Services Task Force recommendations, calling them  "unfounded" and "incredibly flawed," saying that, if adopted, they will "result in many needless deaths." Furthermore, says Lee, they  "seem to reflect a conscious decision to ration care." Lee's organization, of course, has reason to worry about the long-term effects of this report; the American College of Radiology estimates that $3.3 billion was spent on mammograms in the last year alone.

In reality, the mission of the Preventative Services task force is to provide evidence-based recommendations and treatment guidelines for clinicians -- they are not charged with rationing care. Appointed by the Department of Health and Human Services, they are an independent group of 16 experts who specialize in prevention and primary care. True to their mission, the task force members were quite thorough in their research. According to the New York Times "in order to formulate its guidelines, the task force used new data from mammography studies in England and Sweden and also commissioned six groups to make statistical models to analyze the aggregate data."

These six independent groups -- located at academic medical centers -- were comprised of researchers from CISNET, the National Cancer Institute-funded Cancer Intervention and Surveillance Modeling Network. Each group used their own model to examine 20 screening strategies with different starting and stopping ages and intervals. Modeling estimates the lifetime impact (outcomes including benefits and harms) of breast cancer screening mammography.

Their findings were remarkably consistent. In the Times article, Donald A. Berry, a statistician at the University of Texas M. D. Anderson Cancer Center and head of one of the modeling groups says, "The models were the only way to answer questions like how much extra benefit do women get if they are screened every year."