Posts Tagged ‘Medical: mammography guidelines’


newest ama

Radiologist reviews mammogram images. CBS News

Radiologist reviews mammogram images. CBS News

In its lead story, the CBS Evening News (10/20) reported that the American Cancer Society (ACS) has “revised its guidelines for screening for breast cancer.” The ACS “now says that women should get their first mammogram years later than previously recommended.”

In the lead story on NBC Nightly News (10/20), NBC’s Anne Thompson said, “Instead of age 40,” the ACS now “recommends women start at age 45 if they are of average risk, without genetic mutations or a family history of breast cancer. At 55, women should transition to screening every other year if they have a life expectancy of ten years or longer.” Thompson added that the ACS “said the changes are designed to eliminate false positives and over-treatment.”

On ABC World News (10/20), ABC’s Linzie Janis said that the ACS is “also dropping its previous recommendation that women have a manual exam so doctors can feel for abnormalities, because it’s never been shown to save lives.”

USA Today (10/21) reports that these guidelines, published in JAMA, “reflect the growing recognition that mammograms can do harm, as well as good, said Richard Wender, chief cancer control officer at the” ACS.

The New York Times (10/21) reports that “although the new guidelines may seem to differ markedly from the old ones, the American Cancer Society carefully tempered its language to leave plenty of room for women’s preferences.”

Blogfinger Medical Commentary:  By Paul Goldfinger, MD, FACC

I am posting this report because it is meant to guide patients and doctors. Although it brings the mammography controversy into closer alignment among organizations that write guidelines, there still is an element of disagreement about how to use this important diagnostic screening tool, which must be unsettling for all concerned.  Although the lives saved by mammograms are relatively small (see JAMA quote below,) the test is obviously still important.

But what are needed now are some new diagnostic approaches such as the ongoing work in gene analysis looking for markers of high risk.

From the NY Times:  “The changes in guidelines  reflect increasing evidence that mammography is imperfect, that it is less useful in younger women, and that it has serious drawbacks, like false-positive results that lead to additional testing, including biopsies.”

From JAMA  (The Journal of the American Medical Association) which is where these new recommendations were just posted:  “Because the risk of breast cancer is low for women in their 40s and to some extent women in their 50s, the modest relative benefit of 15% translates to a very small absolute benefit (approximately 5 of 10 000 women in their 40s and 10 of 10 000 women in their 50s are likely to have a breast cancer death prevented by regular mammography). 

“The absolute benefit will be higher for women with a higher absolute risk of breast cancer, underscoring the importance of identifying higher-risk women. Especially for average-risk women, decisions to undergo regular mammography screening must also consider the harms of mammography—most notably the possibility of over-diagnosis and resultant over-treatment (age-specific estimates of which are lacking) and also the risks of false positives and unnecessary biopsies (known to be greater in younger women and women screened more frequently).

Even though the onset of screening mammography is now later (45) and becomes every other year rather than yearly after age 55, flexibility in the guidelines provides for women to make  choices such as starting at age 40. It remains to be seen how health  insurance companies will handle these recommendations.

And it remains to be seen how the mammogram  industry (ie Meridian around here) will react to the complexities of the topic when they are busy hanging pink ribbons all over, as if this is a simple matter to figure out.


Read Full Post »

normal mammogram

AMA:    “The American Medical Association adopted a policy at its annual meeting Tuesday that says all women ‘should be eligible’ for screening mammography at age 40, taking a stand in a continuing debate over the benefits and drawbacks of certain preventive services.” In 2009, “the US Preventive Services Task Force (USPSTF) caused an uproar when it recommended against routinely providing mammograms to healthy women before age 50 because there is some evidence that the net benefit is relatively small.” CQ points out that “Health and Human Services Secretary Kathleen Sebelius said afterward that the task force does not set government policy and that women across the country were worried and confused by the recommendation.”

MedPage Today (6/20, Walker) reports, “A number of medical groups, including the American Cancer Society, the American College of Radiology , and the American Congress of Obstetricians and Gynecologists disagreed with the USPSTF recommendations and said women younger than 50 benefit from having routine mammograms.”


One of the characteristics of the new healthcare plan will be an attempt to force doctors to follow practice guidelines. In principal, I support the use of guidelines if they are written by physician experts, if doctors retain control over patient care,  and  if they contain flexibility for the individual situation.  For a doctor who practices evidence based medicine and who places the best interest of the patient first, there is nothing to fear in such guidelines. In fact, such guidelines may  reduce law suits, because if the doctor follows guidelines, his actions may be more defensible in court.   But, as you can see, sometimes these guidelines are wrong, and doctors need to be vigilant as occurred in this mammography situation.

These mammography guidelines were established in 2009  by a “Task Force”  which has been in existence since 1984, under the auspices of the Department of Health and Human Services.  The new guidelines were controversial  when they came out and they still are.  The panel originally consisted of 16 doctors—experts in the field of preventive medicine.   But with the passage of the new healthcare law, another bureaucracy has been layered on top and placed in charge.  They are AHRQ –the Agency for Healthcare Research and Quality.

I am very suspicious of bureaucrats meddling into medicine and I am worried that medicine will be run by government bureaucracies.  Note above where Kathleen Sibelius,  in discussing the guidelines, refers to “government policy.”  I have spoken to a number of practicing doctors, and they all express similar concerns about guidelines, electronic medical records, new mandates to give  GP’s the keys to the kingdom, and huge healthcare organizations created by mergers.    A number of respected physicians have said to me, “You got out just in time.”  There is confusion and low moral regarding the future of healthcare. I’m happy to see the AMA and other specialty organizations speak out for the benefit of patients.

The public needs to pay attention to what happens with healthcare. Don’t be fooled into thinking that higher quality and lower cost will occur together.

Read Full Post »

%d bloggers like this: