In 2009, the U.S. Preventative Service Task Force (USPSTF), a group of medical professionals that work in conjunction with the government, gave their recommendation that women undergo a mammogram screening every two years once they reach fifty years of age; this recommendation is in conflict with the American Cancer Society’s recommendation that women be screened every 2 years once they reach the age of 40. According to the USPSTF, the logic behind their recommendation was, and continues to be, that screening produces more harm than good. They state the following as the harms of mammograms:
Psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure. Harms seem moderate for each age group. False-positive results are a greater concern for younger women; treatment of cancer that would not become clinically apparent during a woman's life (overdiagnosis) is an increasing problem as women age.
Breast Cancer Facts:
According to breastcancer.org:
• Women are more likely to get breast cancer than any other cancer.
• About 12 percent of women will develop invasive breast cancer in their lifetime.
• For 2011 alone, 230,480 women were expected to be newly diagnosed with invasive breast cancer while 57,650 women were expected to be newly diagnosed with non-invasive breast cancer.
Who Are These Medical Professionals?
According to the USPSTF website, “The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).” An LA Times article stated this year that 16 people make up the panel. Since it is not mentioned, whether they are paid to participate in the panel or not is not known; they are chosen through a nomination process, which again, is not particularly detailed.
Who Generally Gets Breast Cancer?
The Center for Disease Control has the following data concerning women’s likelihood of developing breast cancer by age over a 10 year period:
A Woman's Chance of Breast Cancer Development Over 10 Year Period By Age
Age 30-39 40-49 50-59 60-69
Percentage 0.43 1.45 2.38 3.45
Chances 1 in 233 1 in 69 1 in 42 1 in 29
The CDC stated that in 2007, 202,964 women in the United States were diagnosed with breast cancer while 40,598 women in the United States died from it. If 2007 is indicative of, or at least relatively consistent with, every year, then this means that for every 5 breast cancer diagnoses, 1 death occurs. Below is a chart based on 2004 mortality data collected by the Center for Disease Control:
Breast Cancer Mortality Rate By Age (2004)
Age 35-44 45-54 55-64 65-74 TOTAL
Mortality Rate 5.1 13.7 26.8 42.3 87.9
Because of the way the data is presented by the CDC, it is difficult to compare it conclusively to the decade age groups that the USPSTF sets for recommended mammograms. Evidently, however, as age increases, so do the mortality rate. It would more than likely be an underestimation since the mortality rate increases with age, but useful for our purposes, to simply divide each age group in half and add it to the next age group minus half of it to better understand the data; i.e. (5.1/2)+(13.7/2)=9.4 for the 40s age group.
Adjusted Breast Cancer Mortality Rate By Age (2004)
Age 35-39 40-49 50-59 60-69 70-74 TOTAL
Mortality Rate 2.55 9.4 20.25 34.55 21.15 87.9
What to Take from the USPSTF’s Recommendation
Take what you want from the USPSTF’s recommendations, but be aware of the data collected by the CDC. These are the facts in a nutshell:
• Women’s chances of developing breast cancer over a 10 year period increases dramatically when women move from their thirties (1 in 233 chances) into their forties (1 in 69 chances).
• The exact number is hard to know, but based on our adjusted CDC breast cancer mortality rate, women’s chances of dying from breast cancer probably triples (if not slightly more) when women move from their thirties (2.55) into their forties (9.4); women’s chances probably double when women move from their forties (9.4) into their fifties (20.25), which is when the USPSTF suggests women begin getting regularly.
• What is scary about the USPSTF’s recommendation is how seriously people take it; the simple fact is that when most people hear that a government panel suggests not getting certain medical screenings regularly until a certain age, it translates to them that they don’t need to get the screenings at all until they reach that age.
The USPSTF states on its website the following disclaimer about its recommendations, “Information on this Web site is only intended as general summary information that is made available to the public. It is not intended to provide specific medical advice or to take the place of either the written law or regulations. Information resources are designed to help users better understand the health care system, health services research and medical effectiveness, and their own health and diagnosed conditions. Individuals are urged to consult with qualified health care providers for diagnosis and treatment and for answers to personal health care questions.”
So the question is, when you’re in your forties, would you rather be diagnosed with breast cancer only to later find out that you didn’t have it, or die from breast cancer because you weren’t regularly screened for it?
Gina Williams is a guest post and article writer bringing to us information on breast cancer.
Gina also writes about motorcycle accidents for www. motorcycleaccident.org.
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