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November 16, 2009, ST. LOUIS – New breast cancer screening recommendations are raising many questions for women, with some physicians concerned it will lead to fewer women screened annually.

The U.S. Preventive Services Task Force, an independent expert panel in primary care and prevention that reviews the evidence of effectiveness and develops recommendations for clinical preventive services, developed the new recommendations.  They are published in the latest issue of the Annals of Internal Medicine.

After examining the risk vs. benefit of mammography, the task force recommendations for women of average breast cancer risk are:

-Bi-annual screening for women 50-74

-For women between 40-49 years old, routine screening is not recommended, however women should discuss whether they should be screened with their health care provider

-There is no good evidence for average women that self-exam is effective

These are recommendations radiologists at the Siteman Cancer Center's breast health center disagree with.  They support recommendations from the American Cancer Society that women should get annual mammograms starting at age 40 in conjunction with monthly self exam.

“I absolutely endorse the recommendations of the American Cancer Society,” says Barbara Monsees, MD, chief of breast imaging at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

Despite controversy in the past, there is universal agreement that screening mammography saves lives. “That is not in question,” says Dr. Monsees.

There is disagreement, however, in the estimates of how many lives are saved. “This is incredibly important, because in weighing the benefits and the harms, the big benefit here is the number of deaths that can be averted,” says Dr. Monsees.

The task force used an estimate of about 15% reduction in breast cancer deaths.  That stands in contrast to data indicating the breast cancer death rate has decreased by 30% since 1990, when screening mammography began to be widely used.  Before that, the breast cancer death rate had been unchanged for the preceding 50 years.  These recent improvements are felt to be primarily due to screening mammography, although there has been some impact from newer therapies.

“I hope women aren’t confused, I don’t want this to undermine women’s confidence in screening,” says Dr. Monsees.  “Mammograms aren’t perfect but they are a benefit, if you want to do the most you can to prevent breast cancer, you have to include mammography.”