New Breast, Cervical Cancer Guidelines Part Of Long-Running Debate About Cancer Screening

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Although new breast cancer screening guidelines from the U.S. Preventive Services Task Force have "shocked and angered" women across the country, the debate over the risks and benefits of cancer screening has been ongoing for over a decade, according to experts, USA Today reports. The panel's new guidelines say that most women in their 40s should not get annual mammograms and instead should begin biennial mammograms at age 50. The American College of Physicians released similar guidelines for women in their 40s in 2007.

Experts say they modify recommendations as evidence evolves regarding the benefits and risks of cancer screening, USA Today reports. Shortly after the new mammogram guidelines were released, the American College of Obstetricians and Gynecologists altered its guidelines for cervical cancer screening. ACOG now recommends that women wait until age 21 to have their first cervical cancer screening, with subsequent screenings every two to three years depending on the woman's age and medical history. Alan Waxman of the University of New Mexico in Albuquerque, who helped develop the new ACOG guidelines, said that there is overwhelming evidence that cervical screening, when targeted to the right age groups, helps lower cervical cancer rates. Screening women in their 20s allows sufficient time to detect and treat the cancers, which usually do not develop until women are in their 40s, USA Today reports. Similarly, precancerous cervical lesions used to be treated more aggressively in past decades than they are today. Many physicians now choose to monitor such lesions, rather than remove them, in part because it is now known that many go away without treatment and that unnecessary treatment could lead to scarring that can affect fertility, Waxman said.

The breast cancer guidelines are partly aimed at reducing unnecessary treatment. According to USA Today, awareness campaigns have led many women to overestimate the risk of breast cancer for women in their 40s. A recent USA Today/Gallup poll found that 40% of women said there is a 20% to 50% chance that a 40-year-old woman will develop breast cancer over the next decade, though the National Cancer Institute places the actual risk at 1.4% (Szabo, USA Today, 11/30).

Opinion Piece Criticizes Task Force's Delivery of Findings

While the task force's scientists "did their job honorably," it was troubling that they "dropped these guidelines onto an unprepared public like leaflets from a helicopter of experts who didn't understand the conditions on the ground," syndicated columnist Ellen Goodman writes in a Boston Globe opinion piece. "If the experts didn't realize how women would react, they were truly disconnected from the poisonous political atmosphere around health care reform," Goodman writes. Health reform opponents quickly pointed to the panel's recommendations as an example of the health care "rationing" that would result from the passage of the legislation. The ongoing debate over health care reform, the release of the mammogram guidelines and the subsequent release of revised cervical cancer screening guidelines led to a "perfect storm" that "created a perfect case on how not to deliver a public health message," Goodman says. She adds that the task force "had a strong story to tell" because the "benefits of mammography for younger women have been oversold." Ultimately, "facts do not speak for themselves," and they "need to be delivered by people who can listen, frame a message, and prepare the ground," Goodman writes (Goodman, Boston Globe, 11/27).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

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