Staying abreast of cancer

Late last year, the U.S. Preventative Service Task Force reversed its previous recommendations for preventing breast cancer.

Instead of routine annual mammograms for "average risk" women over 40, the new recommendation is once every two years, starting at age 50. The task force also recommended against promoting monthly self-exams.

According to the research backing the new recommendations, for every person saved by early detection, 1,900 women undergo undue stress due to the anxiety of exams, biopsies, and false positive results. That stress is why doctors and researchers have always debated mammography and self-exams.

Get to know your Preventative Service Task Force

The task force is an advisory committee funded by the federal Agency for Healthcare Research and Quality. The recommendations given by the task force are used by primary care physicians and health care agencies. Doctors use the guidelines to best serve their patients; health care companies use the guidelines to decide what services to cover.

According to the agency's website, the task force neither creates nor amends current federal regulations, like the ones in place for preventative breast cancer screenings. They simply research the cost efficiency and health benefits of medical procedures in preventing disease, then release their results.

The face of breast cancer

Ever since the new recommendations were released, some women have been confused about the new guidelines, which promote less screening after the medical community has advocated monthly and yearly screening for years.

"Why would [the task force] say that?" asked Olivia Lewis, a freshman at UC Denver. "Why wouldn't they want to save as many lives as possible?"

Lewis has been affected by breast cancer—her mother and grandmother both passed away at young ages because of the disease, and her aunt underwent a double mastectomy. Her reaction to the new guidelines is on par with other survivors and families of survivors who are outraged by the seeming disregard for public emotion in the haste and poor wording of the guidelines.

"I think if you or anyone you know has survived breast cancer, if you know someone who has died because of breast cancer, or if you have fought for research and early detection methods, you can't ignore that one person in 1,900," said Lewis.

Reaction in the medical community

Self-exams and mammograms are not a new discussion point for members of the medical community. Yet, for the layperson, it is hard to get a definitive answer from experts about how to react.

Dr. Anthony Elias, associate director of the Cancer Center for Clinical Sciences at the Anschutz Medical Campus, responded to the strength of the data presented by the task force.

"I do agree that screening over-diagnoses and that it misses highly aggressive tumors," he said. "However, there is absolutely clear data in all countries that [have] instituted screening that there is a decrease in breast cancer mortality."

Elias recommends preventative measures that parallel previous guidelines:

"To patients with any significant family history or increased breast cancer risk, I would still recommend initiating mammograms at age 40, or 10 years before the earliest in the family. I do not agree with changing to every two years between ages 50-69. I absolutely agree that better screens are needed and that we must be able to differentiate between tumors that are nasty versus those that are unimportant [benign]."

Response from cancer research organizations

The American Cancer Society immediately responded against the new recommendations. In a public statement, Dr. Otis W. Brawley, chief medical officer for the American Cancer Society, explained that previous recommendations were still preferred.

"The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40."

According to a press release from Susan G. Komen for the Cure, an advocacy group for breast cancer victims and survivors, the debate concerning mammograms is a conflict of risk and benefit.

"The most important potential benefit of screening is a modest reduction in breast cancer mortality."

The risks noted in the Komen release are the same risks noted by the task force, which are weighed against the "modest reduction in cancer morality."

The Komen foundation, established in 1982, has been helping to save the 217,440 women diagnosed annually with breast cancer from stigmatization, embarrassment, pain, and helplessness—all feelings associated with suffering from breast cancer—while finding preventative measures and cures.

"We are concerned that this task force organization has caused concern in the community," said Michele Ostrander, executive director for the Denver affiliate of the foundation.

"Susan G. Komen for the Cure continues to advocate annual mammogram screening for women over 40. Mammography is not a perfect tool, but it is the best we have for preventative screening."

Susan G. Komen for the Cure does not stand alone in its stance to fortify previous screening methodology. Secretary of Health and Human Services Kathleen Sebelius took a conservative stance on behalf of the government in a public statement given days after the new recommendations were released.

"My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today.," she said. "Keep doing what you have been doing for years—talk to your doctor about your individual history, ask questions, and make the decision that is right for you."

What women should make of the recommendation