In a long overdue endorsement of the importance of screening mammography, Health and Human Services (HHS) Secretary Tommy Thompson has announced an updated recommendation from the U.S. Preventive Services Task Force (USPSTF). The new guidelines call for screening mammography, with or without clinical breast examination, every one to two years for women ages 40 and over.

The HHS recommendation comes on the heels of a bitter controversy surrounding the efficacy of screening mammography. In October 2002, a Dutch study published in the journal Lancet contended that mammograms have little impact on saving lives from the disease. The Dutch researchers argued that many of the earlier studies that touted the value of mammograms were technically flawed. A subsequent study by Claudia Henschke and colleagues at Cornell Medical Center in New York said that mammograms may save lives, but this was evident only after many years.

Thompson said the new HHS recommendations were not in response to these controversial findings. "I didn't feel any pressure," he said. "I just felt it was the right thing to do."

"The Federal Government makes a clear recommendation to women on mammography: If you are 40 or older, get screened for breast cancer with mammography every one to two years," Thompson said. "While developing technology certainly holds the promise for new detection and treatment methods, mammography remains a strong and important tool in the early detection of breast cancer. The early detection of breast cancer can save lives."

The USPSTF published two earlier breast cancer screening recommendations, in 1989 and 1996, that both endorsed mammography for women over age 50. The USPSTF is now extending that recommendation to all women over age 40, but found that the strongest evidence of benefit and reduced mortality from breast cancer is among women ages 50-69. The recommendation acknowledges that there are some risks associated with mammography (false-positive results that lead to unnecessary biopsies or surgery), but that these risks lessen as women get older.

Simultaneously, the National Cancer Institute (NCI) also reaffirmed its support for mammography. "Early detection of cancer saves lives and we continue to recommend mammography for women in their 40s and older," said Dr. Andrew von Eschenbach, the new director of the NCI. "While we seek improved methods of diagnosis and treatment of breast cancer, today mammography remains an important part of our effort to save lives through early detection."

The new recommendations resulted from a review of eight randomized controlled trials of mammography (four of mammography alone and four of mammography plus clinical breast examination) that have reported results with 11 to 20 years of follow up. These studies have all been published since the task force last addressed this issue in 1996. One of the studies concluded that mammograms did not significantly save lives; another found a 32 percent reduction in breast cancer death from screening mammography; the rest fell in between these levels.

The USPSTF also noted that there remains insufficient evidence to recommend for or against routine clinical breast examination alone as a screening tool for breast cancer and insufficient evidence to recommend for or against routinely teaching or performing routine breast self-examination. While these techniques detect some additional cancers, there was not enough data to determine whether they reduced deaths from breast cancer, the task force said.

SOURCES:
U.S. Department of Health and Human Services (http://www.hhs.gov)
The National Cancer Institute (http://www.nci.nih.gov)