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
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 http://hcc.musc.edu/.
Friday, Dec. 4, 2009