The new United States Preventive Services Task Force (USPSTF) draft recommendations on screening for breast cancer released on April 20, 2015 maintain the status quo at a time when the fundamental philosophy of "early detection" through population-level screening of average-risk women for breast cancer is under question.
Five years after the USPSTF's controversial 2009 breast cancer screening recommendations, the USPSTF has come to remarkably similar conclusions recommending biannual mammography screening for women ages 50-74 and stating that for women in their 40s the decision for routine screening mammography is a personal one. This even at a time when evidence is mounting that mammography screening is failing to meet our hopes of improving and extending women's lives.
In recent years, researchers have elucidated the magnitude of harms and scant evidence of benefits of population-level mammography screening for average-risk women. Not only does this research show that the presumed benefits of mammography screening (reducing deaths from breast cancer) have been overstated, but we now know that the harms have been downplayed. In fact the Swiss Medical Board reported that 22 percent of all breast cancers found through mammography screening represented over-diagnosis, which is the identification of a cancer that is not life-threatening. This means that these women suffer the harms of treatment even though their lives are not at risk.
The data calls into doubt the value of population-level mammography screening for all women, no matter their age. The time has come to radically re-think the tenets of the breast cancer awareness movement, because it is clear that the fundamental philosophy behind "early detection" is flawed.
In the last year alone, The New England Journal of Medicine published a strongly-worded perspective from the Swiss Medical Board concluding that mammography screening is "hard to justify." The British Medical Journal published the largest study on mammography to date, which reported that screening healthy women using mammography to find breast cancers -- before they could be felt as a lump in the breast -- did not lead to lower death rates for average-risk women in their 40s and 50s.
While the USPSTF panel states that women in their 60s derive the greatest benefit from screening mammography in terms of preventing breast cancer death, it does not substantiate the continued recommendation for biannual screening of women in their 50s. All women, whether in their 40s, 50s, 60s, or 70s, should have the opportunity to evaluate the evidence about harms, benefits, and limitations of mammography screening in order to make their own decisions based on their values.
Anyone who has followed the so-called "breast cancer screening controversy" knows that the disagreements about whether and when healthy women should get a mammogram are more political than scientific. For 30 years breast cancer has been political. And it still is. The appalling truth is powerful and heavily-vested interests play a bigger role in breast cancer screening recommendations than does scientific evidence.
The core of the USPSTF draft recommendations for breast cancer screening fail to respond to the tidal shift in data that undeniably questions the efficacy of population-level breast cancer screening. Other countries are following the data: The Swiss Medical Board recommended that Switzerland phase out existing mammography screening programs and stop introducing new ones, according to an April 16, 2014 essay in The New England Journal of Medicine. Why has the USPSTF stayed the course with their recommendations for biannual screening for most middle aged women despite evidence that these recommendations produce significant harm for women?
To submit your comments to the USPSTF on these draft guidelines before May 18, 2015 go to their website: http://screeningforbreastcancer.org/submit-public-comment.