Last Monday the U.S. Preventive Services Task Force issued its guidelines on mammograms, pushing the recommended start age for the average woman to 50 from 40. You’d have to be living inside a mammography machine not to have noticed the maelstrom that has since erupted.
Medical groups like the American College of Radiology and many political opponents of health care reform didn’t waste a second criticizing the group for taking away benefits women need, a first step, they see, towards rationing care. But like those ridiculous signs that sprung up at Tea Party rallies this summer saying “Keep the government out of my Medicare,” everyone seems to have forgotten where the original guidelines originated. They aren’t in the Constitution, and weren’t part of the Hippocratic Oath.
In fact, it was the very same Task Force that recommended mammograms at 40 in the first place. It was 2002, and after examining the evidence, the group (comprised of different experts) suggested 40 as a start age (which is why we don’t now think it’s proper for the average woman to start at 30, or 20). But it also noted that benefits grew over time (meaning those of us in our 40s reaped them least), and that doctors should discuss the harms and limitations of the test along with the advantages. I don’t know about you, but my doctors have never, ever mentioned any harms or limitations. In fact, I get an earful at every GYN and internist appointment for having had only two such tests in the last eight years.
Today we know that breast cancer screening is not the panacea women or physicians had hoped. Despite the fact that it has found so many early cancers, the number of end-stage cancers and the death rate have barely budged. That means the types of cancers found early and the types that kill most women seem not to be the same. That, in fact, is what a fascinating study published last November in the prestigious Archives of Internal Medicine concluded: some initial cancers actually reverse themselves on their own. So early screening may pick up cancers that might not have bothered the woman, but now that they’re found, of course have to be treated. Hence the harm.
Which is why I’m stunned that women in their 40s are among the loudest critics of the new guidelines. Many point to friends who were saved by early detection. But were they? Maybe their cancer would have disappeared without the toxic chemo and radiation. Or maybe it would have grown slowly and eventually been found and treated successfully down the road. There is a chance their screening mammogram was in fact their savior, but the stubbornly persistent death rate even after mammography was widely embraced implies that is not the norm.
Women in their 40s have also been shouting about friends or relatives who tragically didn’t get a mammogram as justification for the test. Dying young of breast cancer (or any disease) is heartbreaking. But when a volunteer at the American Cancer Society claimed that a lack of screening is what killed her fortysomething cousin, I had to disagree, and I believe many medical experts would also. Despite intense chemo, radiation, surgery and everything else her doctors could throw at her, the woman was gone in six months. That aggressive, virulent type of cancer likely wouldn’t have responded no matter when it was found.
The new guidelines say that women with a personal risk should of course get screened earlier. But the rest of us, who thought starting at 40 was based on solid evidence, should now realize that evidence (expanded since the 2002 declaration) more strongly points to 50. Rather than scream about the experts taking something (that they gave us in the first place) away, we should thank them for keeping us from unnecessary harm.