Breast imagers join backlash against new mammography guidelines

Powerful political forces are lining up with radiologists and mammographers against guidelines from a federal panel that scrap longstanding policies for the timing of screening mammography. Even the U.S. Department of Health and Human Services is distancing itself from its panel's recommendations in the wake of criticism from many women's health advocates and breast cancer survivors.

On Monday, the U.S. Preventive Services Task Force (USPSTF) published revised guidelines in the Annals of Internal Medicine recommending against screening mammography for women in their 40s and screening every other year for women from ages 50 to 74. (See: Federal panel says screening mammography should begin at 50; experts outraged). The revisions replace the task force's own 2002 guidelines and challenge broadly accepted recommendations for annual mammography beginning at age 40 that are backed by the American College of Radiology and the American Cancer Society.

Dr. Ellen Mendelson, director of breast imaging at Northwestern University, called the USPSTF actions "an abomination."

"The USPSTF trivializes the 15% reduction in mortality for women under 50 (attributed to screening mammography)," Mendelson said. "Fifteen percent is not trivial, and we're not just going to throw these women out."

Mendelson pledged that the women's health program at Northwestern University will continue to stand by the ACR and ACS guidelines.

The magnitude and emotional tenor of the public response has been unprecedented for an issue related to diagnostic imaging. The news and the public and political fallout it generated earned top billing three days in a row on ABC, CBS, and NBC nightly news broadcasts. CNN had assembled an expert panel within hours of the announcement to debate the guideline's merits. It was the subject of editorials in most daily newspapers and was considered in numerous blogs and letters to the editor.

Complaints raised by the ACR and ACS are being backed up by accounts from breast cancer survivors, who say they would have fared much worse under the screening regimen suggested by the USPSTF.

Even DHS secretary Kathleen Sebelius distanced herself from the recommendations of her own department's panel. She urged women "to do as they always have done" and get an annual mammogram. In deference to the new guidelines, she advised women to discuss screening mammography with their doctors to decide what's best for them. She expressed doubt whether private insurers would cut benefits to reflect the USPSTF recommendations.

"The task force has presented some new evidence for consideration, but our policies remain unchanged," she said. "Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action."

If the USPSTF guidelines are followed, radiologists will see more advanced disease, more mastectomies, and more deaths related to breast cancer, said Dr. Kathy Schilling, medical director of breast imaging at Boca Radiology in Boca Raton, FL.

Mammographers contacted by Diagnostic Imaging say women have not called in to cancel their mammography appointments, but receptionists at Boca Radiology are prepared for that possibility with a script letting patients know that 40 is still the age to start screening.

Some patients at Elizabeth Wende Breast Care in Rochester, NY, have called back after scheduling a follow-up appointment to ask if their visit was necessary considering the new recommendation, said Dr. Stamatia Destounis, a radiologist there. The patients were told to still come in.

At Elizabeth Wende, women aged between 40 and 50 had 22.2% of all cancers; 34.3% were found through screening mammogram, Destounis said. "By going to no screening in the 40+ age group and [screening] every other year in the 50+ age group, we will lose all the benefits for women we have worked so hard for," she said. "We will find cancers when they become palpable and may be metastatic. The size of the tumors will be larger and so will the lymph node involvement rate."