When to change the standard of care: Taking a second look at mammogram recommendations

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To say that the issue of breast cancer has become pervasive in our day-to-day lives would probably be a gross understatement — in fact, the concept of breast cancer awareness may be headed towards becoming a moot point. Walking down the street on any given day, we are likely to see individuals of all backgrounds sporting pink ribbons, pink t-shirts, pink grocery bags….maybe even a pink handgun. For women, the message that “early detection saves lives” is drilled into our brains decades before we will ever receive our first truly invasive cancer screening. What has resulted from all of this attention, though, has been a complicated landscape for women, who have been faced with the difficult task of teasing out the best decisions for their own personal health amidst a frenzy of prevention recommendations, most notably that of encouraging every woman over 40 to receive mammograms on an annual basis.

Recently, the tables have turned on what was once considered the gold standard in breast cancer screening. Guidelines from the U.S. Preventive Services Task Force (USPSTF) in 2009 recommended that women delay their first mammogram until after turning 50, and that they should be screened every two years rather than the previous norm of annual screenings. These new screening recommendations have only just recently been brought into the limelight — after 5 years of virtually unnoticed existence — in conjunction with the recent media attention surrounding a new study that suggests the benefits of yearly screenings may not outweigh the potential risks involved, which include false positive test results, over-diagnosis, and even relatively large numbers of unnecessary tissue biopsies. This information may put a strain on physician-patient relationships and trust, since it appears that many doctors had previously been downplaying the potential negatives of mammograms to their female clients.

The JAMA article is not the first time that robust research has shown mammograms to be much less reliable than women have been lead to believe. Earlier this year, The British Medical Journal released a study demonstrating that screening with mammograms between the ages of 40-59 offered no significant protection against breast cancer mortality, and rather led to over-diagnosing of the disease. Yet, in spite of all this evidence suggesting that using mammograms to screen for breast cancer — particularly at younger ages — may be not only ineffective but also detrimental to women’s health, confusion around best practice routines by doctors and even more so for patients remains rampant. Even The American Cancer Society continues to recommend annual mammograms for all women over age 40. As is so often the case, women are left to pick up the pieces and try to solve the puzzle of what is best for their health on their own — a difficult task for a highly scientifically-educated woman, no less a woman whose medical knowledge is limited and is struggling to simply make ends meet.

With such a vast change in information that we have about screening with mammograms, what are doctors’ responsibilities to their patients, and how can we provide the best care to the most women possible? Unfortunately for medical professionals — but as with most good medical practice — it seems that there is no single solution for everyone. The best strategies for breast cancer screening should ideally be tailored to the individual needs of the patient. In light of these recent findings, it is possible that our society will continue to push towards increased genetic screening for breast cancer risk, which would help identify the specific individuals who would most benefit from routine mammograms. Hopefully, increased conversation around what qualifies as best practice for breast cancer screening will empower women to take greater interest in and control over their own health care decisions, switching the norm from patients being told what to do by physicians to a conversation between doctor and patient.

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