New guidelines, new worries

A task force report says that most women don't need mammograms in their 40s and that women 50-to-74 should have the screening exam every other year rather than annually. The same panel says that breast self-exams are not useful at any age. Those guidelines, which differ significantly from long-established practice, prompted considerable concern among individuals, health care providers and advocacy groups.

The worry is understandable. Regular mammograms beginning at age 40 and self-examination have been cornerstones of breast cancer prevention programs for decades. Given that, any change in a regimen is bound to be controversial. That proved to be the case when new guidelines from the U.S. Preventative Services Task Force, an independent panel appointed by the U.S. Department of Health and Human Services, became public on Monday.

The report, based on analysis of available data, does not challenge the utility of mammograms. Rather, it concludes that early and frequent screenings often can lead to false positives, unnecessary biopsies and unnecessary treatment without greatly improving a woman's chance of surviving breast cancer. "The benefits are less and the harms are greater when screening starts in the 40s," said the physician who was vice chair of the panel. The might be true statistically, but it is a nuance that escapes many women.

That's especially true with women in their 40s, or younger, whose cancers were discovered during routine mammograms and then treated successfully. Many health care providers and advocacy groups echo those concerns, though condemnation of the new guidelines is not universal. There is, in fact, already vigorous debate about their validity.

The American Cancer Society, the American College of Radiology, and many physicians criticized the new guidelines and said they would continue to advocate early screenings. Some agencies, like the National Cancer Institute, said it will study the new guidelines before making official comment. Other groups, physicians and individuals welcomed the recommendations. No wonder confusion abounds among women and those who love and care for them.

The debate about the new mammogram guidelines will continue on two levels for months, if not years. The first is personal and medical; the second political and economic. Neither will be resolved easily.

There are those who view the new report as a prelude to government rationing of health care. Still others say insurance companies will use the guidelines as an excuse to stop paying for routine mammograms for certain age groups. There's no indication either is true, but public awareness of the possibilities is the best deterrent to rumor becoming fact.

On the personal level, women and their health care providers jointly should weigh their medical history, comfort level and the new guidelines when making a decision about mammograms. That's been the best path to follow in the past. The new guidelines do not change that.