A government appointed task force is now recommending that women start mammographic screening at age 50, do it every other year and stop at age 74 (ref. 1A). These guidelines are based on flawed science (ref. 2 -4). I am convinced that the committee’s primary goal in making these recommendations was cost-containment. The issue of how these guidelines would adversely impact women’s health was essentially ignored.
The Problem: We are already seeing the ill-effect effects of the committee’s recommendations. Women are confused about conflicting guidelines, and many are content to delay screening until age 50. Doctors don’t have time to discuss screening options, and some have now stopped ordering mammograms for women in their 40s.
However, the most important effect of the new guidelines is that it gives insurance companies an excuse not to pay (ref. 1b) Already, our patients are discovering that some insurance companies are denying payment for mammograms. Unless something is done to reverse this trend, insurance companies will undoubtedly expand their efforts to deny payment for screening mammograms.
The impact on women’s health will not be immediately apparent, but in the near future it will become clear the new guidelines are leading to diagnostic delays. More women will be diagnosed with advanced cancer requiring more aggressive treatments (chemotherapy, surgery & radiation). Breast cancer mortality rates will rise. Young women will die needlessly and children will grow up without their mothers.
The irony is that this is taking place at a time when incredible progress is being made in the early detection of breast cancer (ref. 5). We now have new technology (3-D mammograms, screening breast ultrasound and breast MRI) that gives us the potential to reduce breast cancer mortality by more than 50% (ref. 6). Thus, just when we are making great strides in breast cancer care, we on the verge of taking a major step backward.
The key to reducing breast cancer mortality is to start yearly mammographic screening at age 40 and younger if at high-risk (average risk ref. 7: high-risk ref. 8). Breast cancer is a disease of younger women (ref. 9). More years of life are lost for women diagnosed with breast cancer in their 40s than all the years of life lost for women 50 and over. Additionally, the majority of lethal breast cancers occur in women who were diagnosed before the age of 50.
It is time to fight back. We are starting a grass roots campaign to protest against these new guidelines, and to educate women about the value of early detection. The campaign is called 40 not 50 and we need your help. What you can do:
Don’t allow a government-sponsored agency reverse the progress in early detection that has been made in the past decade. Don’t let policies be established that will lead to the loss of life of young women because of a delay in diagnosis of breast cancer.