The U.S. Preventive Services Task Force has put forth new guidelines for screening mammogram in women ages 40-49, annually mammograms in women 50 and older and self-exams. The recommendations from the federal government-funded committee has created confusion and raised questions.
The task force has always suggested an annual mammogram starting at age 40 and encouraged self-examination. The task force recommends against routine mammograms for women until they are 50 or older. The report called for routine screening every two years for women ages 50 to 74.
Perhaps most surprisingly the committee says no more monthly self-exams to perform to detect lumps, bumps or other changes in breast tissue that could be a sign of breast cancer.
The analysis by the task force seems sound on paper. According to the panel, a staggering 10 percent of mammograms result in false-positive readings that lead to unjustified worry and needless procedures, for example biopsies.
The reality is, every year, 43,000 women die from breast cancer, but many of those deaths could be avoided if more women had regular mammograms. Mortality from breast cancer has decreased by 2 percent per year over the last 10 years due in large part to improved mammography and dedicated screening programs. These new, government-endorsed guidelines will be a significant setback to the gains that have been made.
Although the task force said it did not consider costs, there is also an undisputable financial effect of the shift as well. Around 37 million mammograms are administered annually. Each one costs about $100. So reducing the number of mammograms could result in billions of dollars in savings. The U.S. does a better job of treating cancer than any country in the world in part because of the screenings, which may not be covered in many other countries.
Your numbers are suspect and do not marry with the published research (meta-analysis of lots of other studies). The recommendations are based on actual numbers of deaths without routine screening compared to routine screening between ages 40-50. The difference between the two approaches shows a differnce in mortality of 680 people per year. And 220000 or so false positives along with, if I recall correctly, many thousands of unnecessary procedures (biopsies, mass removals etc.).
Changes in HRT and improvements in treatments (such as increased levels in Chemo) have a great impact in recent cancer rate reductions (though I am by no means suggesting that at the right time, with sensible intervals mammograms are not essential) than mammograms on the age group under review. Even mammograms, with all their false positives are only about 80% successful in spotting cancers. You also fail to divide progress in overall breast cancer reduction rates into age groups. The reason for NOT recommending routine scanning is directly referential to age, arguments FOR routine scanning should also have statistics which likewise refer to age.
You seem to be advocating all women in the specified age group (40-50) should continue testing, then you’re (using you figures) looking at an annual cost of about $2.2 billion, for 680 lives per year. That’s $3.2 Million per extra life for diagnosis (compared to not having routine annual screening). That is (close to) the actual cost per life, this rarely gets a mention. Personally I think it’s worthwhile, but you can see why the procedure might be under review.
Your statement suggesting that more women would live if more had mammograms is most relevant when applied to specific age-groups; you could reduce the number of deaths by scanning a greater proportion of / all 50-65 years olds far more effectively than continuing the 40-50 age group, not to mention the hundreds of thousands of false (proportionally greater) positives in the younger group.
US cancer treatment rates great, but little or no heed is paid to the fact that they include a number of treatments for cancers which are, essentially unnecessary treatments on benign growth. The fact is that testing, particularly breast cancer testing, is not very accurate (10% false positive, 20% false negative). This is perhaps where the biggest and most effective improvements could be made.