Approximately 231,000 women will be diagnosed with breast cancer by the end of 2015, resulting in more than 40,000 mortalities, according to the National Cancer Institute. The median age for diagnosis is 61, while the median age of death is 68. To reflect those numbers, the U.S. Preventive Services Task Force released a draft for updated guidelines for mammogram screenings.
Reaffirmation of guidelines to reduce harms
While not much different than its predecessor, the 2015 version of breast cancer screening protocol suggests biennial testing for women aged 50 to 74 instead of a minimum age of 40, as it was in the past. This type of cancer caused the deaths of 42.9 percent of women aged 55 to 74 as opposed to 19.9 percent of females aged 35 to 54. The USPSTF revised the guidelines to increase the benefits to those women while reducing the risks to those who fall below that age range.
With the screening age lowered to 40, there were 576 more false positives that resulted in 58 unnecessary biopsies, according to the proposal. The increase in the minimum age for screening would prevent avoidable anxiety for patients who could could receive one of those 576 false alarms, Time magazine explained. Of course, the new age limits do not prohibit women from receiving diagnostic imaging exams. The USPSTF recommended that women with a family history of cancer and those who were previously at risk be screened along with the 55 to 74 year olds. Patients younger than the recommended age can also discuss screening with their doctors and make informed decisions on what works best for them.
“Mammography helps,” Michael LeFevre, M.D., former chair of the USPSTF, told the source. “We can reduce women’s likelihood of dying of breast cancer by undergoing some regular screening at some interval during certain ages. That is a common theme across almost all organizations that look at this. We think we should be doing it in a way where we maximize the balance of benefits and harms. That is our top line message and that is what I hope women hear.”
USPSTF faces criticism
The new draft for breast cancer screening guidelines serve only as recommendations, not mandatory rules to be followed. Yet, the USPSTF still faces backlash for its suggestion to remove women aged 40 to 49 from its proposal.
The main concern involves the cost of medical imaging, Modern Healthcare explained. The Patient Protection and Affordable Care Act requires private insurance companies to cover payments for preventive exams and treatments that receive at least a “B” grade from the USPSTF, which recommends that medical practices provide the service, according to the Centers for Disease Control and Prevention. However, with mammography’s new “C” rating, insurers will not have to cover the screening for all patients.
“While empowering women to make an informed decision about screening is laudable and something that the American Cancer Society also recommends, we are concerned that the ‘C’ rating might lead to coverage for fewer women and more out-of-pocket costs for women in their 40s,” Richard Wender, M.D., chief cancer control officer of the ACA, told the source. “Costs should not be a deterrent to women who otherwise would seek to have a mammogram.”
The USPSTF invites the public to comment on the draft until May 18, when it will finalize the guidelines.
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Ronny Bachrach
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