Task Force Chief Defends Controversial Mammogram Recommendations

The chairman of the task force recommending that most women start breast screening at 50 rather than 40 says he is not surprised by the controversy the new guidelines have generated, but he stands behind them as “the best recommendation that the science would support.”

“Understanding the amount of advocacy that goes on around breast cancer screening, I think we were pretty certain this would cause a stir,” Dr. Bruce N. Calonge, chairman of the U.S. Preventive Services Task Force, told On Point host Tom Ashbrook in an interview. “We felt that the recommendations are supported by the evidence and the science.”

The recommendations, issued Monday by the independent federal task force, reversed guidelines American women have been given for decades: advising against routine mammograms for women under 50 without special risk factors. For women age 50 to 74, the panel now recommends breast screening every two years, rather than every one to two years as previously advised.

The point, Calonge said, is that the 15 percent mortality reduction that results from regular mammography for women in their 40s — an age group for which breast cancer is relatively rare — does not outweigh the “definite harms” associated with the exams.

“We felt we had to put out the best recommendation that the science would support.”

–Dr. Bruce N. Calonge, U.S. Preventive Services Task Force

He said the task force had carefully constructed the wording of the recommendation to advise against routine screening for women under 50, not against mammograms in general.

“The decision to start screening before the age of 50 should be an individual choice,” Calonge said, “taking into account patient characteristics, patient history, family history, hormonal status — all the issues that will help a woman decide.”

“If you think about that,” he said, “I have a hard time understanding the controversy around: A woman should understand the limits of the test, the harms of the test, the potential benefits, and then make her own decision.”

Women who undergo regular screening are more likely than other women to go for a biopsy, Calonge said, yet “most of those biopsies do not translate to benefit,” meaning the mortality rate is not significantly different from that of women who do not have a biopsy. “The vast majority of breast biopsies in that age group aren’t making a woman live longer,” he said.

In another surprise reversal, the task force Monday said doctors should stop advising or teaching women to regularly examine their own breasts. As with regular screenings, Calonge said, self-examinations result in more unnecessary biopsies — without any impact on mortality.

“If you set aside the anecdote and you actually look with the lens of science, you say, ‘Boy if I teach one group of women to do breast self-exam and another group of women to not … the group I teach does have more breast biopsies, but their mortality is not changed at all,’ ” he said. “Rather than saying there’s not evidence of effectiveness, we have good evidence of no effectiveness.”

That advice should not be interpreted to mean that if a woman finds a lump in her breast, she should not go to the doctor, Calonge stressed. “Absolutely women should,” he said.


Listen to Ashbrook’s full interview with Dr. Calonge, Nov. 18, on “On Point.”

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