USPSTF mammography guidelines spark debate
The US Preventive Services Task Force (USPSTF)’s updated recommendations on mammography are open for public comment, prompting renewed debate about the value of screening in women younger than age 50. The draft document reaffirms the panel’s controversial finding in 2009 that decisions about baseline mammography at ages 40 to 49 should be individualized and, for the first time, reviews evidence for tomosynthesis or 3-D mammography.
Grading the evidence a B, the USPSTF came out in favor of biennial screening mammography for women aged 50 to 74. The panel rated a C evidence supporting screening mammography in women aged 40 to 49, commenting that, “The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.” Evidence was insufficient, the USPSTF recommendations indicate, to support screening mammography in women aged 75 years and older.
In assessing new technology for screening, the panel found insufficient evidence to recommend use of 3-D mammography for primary screening. A similar comment was made about use of ultrasound, magnetic resonance imaging, 3-D mammography or other modalities for screening specifically in women with dense breasts. The USPSTF did not update its recommendation against clinicians teaching breast self-examination to patients (D recommendation) but said it is important for women to report lumps or other significant changes in their breasts to their healthcare provider.
In response to release of the draft recommendation statement by the USPSTF, The American College of Obstetricians and Gynecologists (ACOG) issued a Practice Advisory to Fellows, noting that the update is in keeping with its practice bulletin on breast cancer screening, particularly regarding women aged 40 to 49, and indicating that ACOG plans to submit formal comments to the Task Force.