Mammography draft recommendations from the US Preventive Services Task Force (USPSTF) were covered by two of last night’s national news broadcasts and by several major US newspapers, wires, and websites. Much of the coverage focuses on the “controversy” surrounding the recommendations.

NBC Nightly News (4/20) reported that the USPSTF “says women over 50 should get a mammogram every other year.”

Meanwhile, ABC World News (4/20)  reported that the task force recommends “women in their 40s should get mammograms every other year if they are very concerned.”

USA Today (4/21, Szabo) reports that “the American Cancer Society, American Congress of Obstetricians and Gynecologists and the American College of Radiology recommend annual mammograms beginning at age 40.”

Bloomberg News (4/21, Tracer) reports that in a statement, the US Health and Human Services Department said, “Because the recommendations are draft, nothing has changed as far as access to mammograms or other preventive services that insurers are required to cover with no cost sharing.”

Blogfinger Medical Commentary   by Paul Goldfinger, MD, FACC

Soon the painters will arrive to put a bright pink stripe down Main Avenue, and the banner hangers will be here to place pink bows on everything that’s vertical.  Blogfinger ran some articles in 2014  on breast cancer screening:

Our most controversial piece was this one from last May:   http://blogfinger.net/2014/05/04/paint-the-town-pink-is-this-really-appropriate-for-an-entire-month/

And another post from Feb. 2014:    http://blogfinger.net/2014/02/02/the-mammography-mess-a-controversy-with-conflicting-information/

Some readers were upset over that May, 2014  article, but the subject of screening for breast cancer is much too complicated and serious to be color coded and hung all over town like some St. Patrick’s Day festivity.  For the last 6 years, at least, experts have been debating how to use mammography in the most effective way to detect disease and save lives.

I am no expert in breast cancer, so I have not weighed in on the particulars of the controversies, but I can be helpful in acquainting you with the uncertainties that exist. As much as concerned citizens want to help in “the fight against breast cancer,” there is a tendency to oversimplify medical topics such as how to best use mammograms.

This is from the chief Medical Officer of the American Cancer Society, Otis Brawley, MD:

“People in the United States think that breast cancer screening is better than it is,” Brawley says. “We have done a poor job at explaining the limitations of mammograms.”  Brawley says researchers urgently need to come up with more effective breast cancer screenings, noting that too many women still die from the disease, including many who were screened early.”

And this quote is from the LA Times regarding yesterday’s new draft report discussed above.

“The draft report from the U.S. Preventive Services Task Force reiterates that mammograms performed on asymptomatic women do indeed save lives. But it also emphasizes the test’s downsides, many of which are underappreciated by doctors and the general public.”

I hope that these articles help give you a sense of the imprecision which often exists in medical situations where the public wants certainty but can’t get it and reacts with frustration. The mammography controversy is particularly heated, even among cancer experts. It is not uncommon for doctors and their patients to have to live with uncertainty.  Everytime we answer a question in medicine we wind up with twenty new ones.

Citizen groups interested in helping with breast cancer screening will do a lot of good if they get really active in education by going door to door, or on the corners, and talking to women, especially in high risk categories.