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HCC responds to USPSTF recommendations

by Megan Baker, M.D.
Hollings Cancer Center
The Comprehensive Breast Care team at MUSC's Hollings Cancer Center strongly opposes the screening mammography re-commendations released by the United States Preventative Services Task Force (USPSTF).
We believe that the data presented are not compelling enough to abandon evidence-based, validated screening mammography guidelines.
In the USPSTF analysis, screening mammography has been shown to reduce mortality in every age group, including women, age 40-49, and women older than 74 years old. Admittedly, this comes at the cost of false positive results and additional procedures.
In the group most at-risk for this issue, those 40-49 years old, five women will undergo an additional biopsy procedure for every breast cancer detected. This screening schedule, however, will reduce breast cancer deaths in that age group by 15 percent.
To be most efficient with resources, the USPSTF deems it acceptable to lower the sensitivity of a national screening mammography program from the current detection rates of 90 percent of all breast cancer to 70 percent in the future. In an era of limited resources, when early detection and prevention are paramount and critical for cost savings, this recommendation is ill advised.
Furthermore, the task force recommends that women undergo yearly risk assessments to evaluate their need for a mammogram. Unfortunately, this risk assessment is rarely performed; and a significant gap in health care education from providers remains.
Additionally, the task force did not account for the shift in disease progression that will occur. With earlier detection, we have made tremendous strides in preserving women’s breasts, decreasing the need for mastectomy (removal of the breast) by more than 40 percent in the past 20 years. If we allow breast cancers to grow undetected, this will result in more mastectomies and increasing use of chemotherapy.
Unlike other health care systems that were included in this analysis, the U.S. health care system is not structured to ensure that women will be encouraged or compliant with these recommendations. Much of the success of our current screening recommendations lies in their simplicity.
We, at Hollings Cancer Center, are joined by our colleagues in the American Cancer Society, the National Comprehensive Cancer Network, the American College of Radiology, the American Society of Breast Disease, the American Society of Breast Surgeons, the Susan B. Komen Foundation, and the American College of Obstetricians and Gynecologists in our opposition to these current recommendations and our continued advocacy on behalf of our female patients.
For information on MUSC's Hollings Cancer Center, visit

Friday, Dec. 4, 2009

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