The fact that there is a downside to mammography has not been readily explored, but now the American College of Physicians is smelling the coffee:
The American College of Physicians (ACP) recommends tailoring the decision about screening for breast cancer in women aged 40 to 49 years based on the woman's concerns about mammography and breast cancer and her risk for breast cancer because of the associated benefits and risks for this age group. The new guidelines appear in the April 3 issue of the Annals of Internal Medicine, along with a background review article, an editorial, and a patient summary.Read the entire report here.
Available evidence suggests that breast cancer risk, and therefore the benefit of screening mammography, is not evenly distributed in women between the ages of 40 and 49 years. When weighing the possible benefits and harms of screening mammography, one must therefore consider individual risk for breast cancer, as well as susceptibility to and concerns regarding the harms of screening.
"We designed our screening mammography guideline based on scientific evidence," Lynne Kirk, MD, FACP, president of the ACP, said in a news release. "It will empower women between the ages of 40 and 49 to become part of the decision-making process and to encourage them to discuss with their physicians the benefits and risks of mammograms.... If a woman between the ages of 40 and 49 decides not to have a mammogram, she and her doctor should re-address the issue every one to two years."
Following a rigorous process based on extensive review of available scientific evidence, the ACP panel developed evidence-based guidelines rather than expert-opinion or consensus guidelines. In addition to articles reporting findings from the original mammography trials, the ACP panel reviewed 117 studies concerning the risks and benefits of mammography screening for women between the ages of 40 and 49 years.
The ACP panel concludes that evidence is insufficient to recommend for or against screening all women in this age group for breast cancer. The guidelines recommend that women discuss breast cancer screening with their primary care clinician and make the decision that best suits their specific risks and individual preferences.
"It is important to tailor the decision of screening mammography by discussing the benefits and risks with a woman, addressing her concerns, and making it a joint decision between her and her physician," says lead author Amir Qaseem, MD, PhD, MHA, from the Medical Education and Publishing Division at ACP.
Read some previous cautionary posts on mammography for which some readers are giving me some crap! (here's another one)