What Does Dr. Susan Love Think of the New Mammography Guidelines?
Did the new mammography guidelines from the U.S. Preventive Services Task Force come about because a review of the scientific evidence shows that there is no data to support the idea that the benefit of mammography outweighs the risks for women between the ages of 40-50? Or was it a political decision?
Whenever I’m confused about what to think when it comes to breast cancer, I always check what expert Dr. Susan Love thinks. Her response is too nuanced to summarize here, so I will direct you to her website so you can read her post on the current controversy over mammography.
Here’s a brief excerpt:
The problem with mammography in women under 50 is that it doesn’t work very well. Breast tissue is dense in young women and appears white on a mammogram. Cancer also appears white on a mammogram. This means that trying to find cancer on a young woman’s mammogram it is like looking for a polar bear in the snow. As a result, mammography misses many cancers in young women. And not only does it miss many cancers –- giving a false sense of security –- it also finds many things that are NOT cancer but need to be checked out through biopsies or other tests. In addition, the risk of the radiation is higher in younger women.
The magic of 50 is menopause. As a woman’s hormones wane her breast tissue becomes less dense and the mammograms become easier to read, shifting the risk benefit balance. Before 50, it’s a different story.
November 19th, 2009 at 3:50 pm
I was actually at a seminar on Tuesday where I was talking to the head of the NIH Library (I’m a medical librarian/web content type). She said that 10 years ago a similar recommendation was proposed by an NIH Technical Expert Panel but due to all the pressure from breast cancer groups it got squashed. This is nothing new.
November 19th, 2009 at 6:03 pm
Dr. Love’s take on this issue brings a level-headed tone to the debate. I also recall previous recommendations on mammography that suggested different frequencies for different age groups. In the end, recommendations are just that and not prescriptions. It’s your own risk factors that should determine what protocols you should follow.
November 19th, 2009 at 8:49 pm
Why is it that the news media talks about the politics, the women under 40 who were saved, etc., but no one mentions the difference in breast tissue. We can’t seem to get straight stories on anything.
November 20th, 2009 at 12:41 pm
Of course! It seems so obvious that mammograms are not diagnostically effective in younger women. And that did not even occur to me. The media have really confused the issue. I should have understood this matter and would have if the reports had been straightforward.
November 22nd, 2009 at 1:57 am
This new recommendation — mammograms after 50 — is how it works in the UK. Also we only get them every 3 years. I always thought it was a cost saving measure and that Americans — INSURED Americans, that is — got better care.
It is exactly the same with PAP smears. UK guidelines do not routinely give the test to women under 21 and they are only given every 3 years. Again, I thought this was an example of inferior care.
Turns out it is an example of “evidence based” health care. The news today said that many Americans would find it difficult to accept the new evidence based system.
I wondered why anyone wouldn’t want evidence based health care.
The trouble is trusting the evidence source. It is so hard to get at the hard science. What gets reported is always so simplified that it, ironically, becomes incomprehensible.
November 22nd, 2009 at 8:33 am
Great comments all around. Thanks, friends.