Porter Hospital Blog

Last week, a government task force suggested new guidelines for screening women for breast cancer in a paper published in the journal Annals of Internal Medicine. Since that time, the public conversation about these new guidelines has been heated and, possibly, confusing to many of us.  Why there is so much public debate, and how the medical community is processing this controversy was what we discussed this week on Channel 7’s 11 am news.

First of all, what is different in the new guidelines compared to the older ones?
The suggested new guidelines differ from current practice in some fairly significant ways;
1) The new guidelines suggest starting routine mammography at age 50, while age 40 is the current practice
2) The new guidelines suggest doing away with monthly self-examination by patients
3) The new guidelines question the use of clinical breast exams for early detection

Why is this causing so much controversy?
The new study was a search of the medical literature, not a clinical patient study. The study was set up in a risk/harm format which is a less common type of method for looking at the literature. The critics of the study have the following major points:
1) The study did not include a look at studies that some breast cancer experts consider very important to understanding appropriate care
2) The study made some assumptions about “harm” – including that women see finding breast lumps/abnormalities that are biopsied and found to be normal as “harmful” The breast care experts say that this assumption is not reflective of how women actually perceive
3) Clearly the evidence shows that the death rate from breast cancer is significantly less than it was 10 to 20 years ago. This is felt to be primarily due to early detection and treatment. Much of the controversy is around why we would change something – the current screening and detection protocols – that is known to be working.
It sounds as though the medical community has a lot of work to do to come to a new, unified, understanding of how to approach breast disease. What should women do in the meantime?
It is true that there will be a great deal of debate in the medical community based on these suggestions that vary significantly from current practice. And as with anything new in the medical literature – this is one study among volumes of literature.

So, while the debate continues , the Secretary Sebelius of the United States Health and Human Services and the American Cancer Society, along with the American College of Radiologists and the American College of Surgeons, are recommending that women continue to follow the current, more conservative recommendations of starting screening at age 40 and doing self breast exams.
And remember – guidelines are general directions for physicians to consider – but you should always consult with your physicians to get the individual recommendations tailored by your physician to meet your specific situation.

Good Health to you!

Dr. Dianne