U.S. Advisory Board Recommends Cutting Back on Mammography Screening

“Switch to every two years starting at age 50,” is the advice the U.S. Preventive Services Task Force has provided on mammography screening following a cost and benefit analysis of the recommended annual exam.

The group evaluated the U.S. breast cancer screening strategy using six models with common data elements. Screening biennially produced up to 81 percent benefit of the current annual screening, with half the false positives from annual exams. Screening every two years also achieved a median 16.5 percent reduction in mortality versus no screening. Screening initiated at age 40 added another estimated 3 percent reduction.

For women age 69 and older, biennial screening “yielded some additional mortality reduction in all models, but over-diagnosis increased substantially,” according to Jeanne Mandelblatt, M.D., MPH et al.

“Also, although our models project mortality reductions similar to those observed in clinical trials, the range of results includes higher mortality reductions than that achieved in the trials because we model lifetime screening and assume adherence to all screening and treatment,” the task force wrote in recommendations at http://www.ahrq.gov/ clinic/uspstf09/breastcancer/brcanart.html. “

The task force acknowledged that recommending this change would negate what it termed the small benefits accrued from screening women age 40 to 49.

“Benefits in this age group were also associated with harms in terms of false-positive results and unnecessary biopsies,” the group concluded. “Thus, although strategies that include annual screening from ages 40 to 49 years might be efficient, this would be largely driven by the more favorable balance of benefits and harms after age 50 years. In addition, we judged that mixed strategies are very difficult to communicate to consumers and implement in public health practice.”

In the face of groups and agencies protesting the proposed change from annual to biennial breast cancer screening, the National Cancer Institute issued a statement on Wednesday that the agency will continue to follow the current recommendations.

“The take-away message is that each woman needs to consider her individual benefits and risks and discuss them with her health care provider before making a decision on when to start screening mammography and how often to get one,” the NCI stated in a press release.