This past week the United States Preventive Services Task Force revised their guidelines for baseline screening mammograms. Their decisions were closely monitored and commented upon.

This past week the United States Preventive Services Task Force revised their guidelines for baseline screening mammograms. Their decisions were closely monitored and commented upon.

 Before this, most Americans probably had not heard of the USPSTF (“Task Force”). The Task Force, what do you know?



True or False

1. They are employed by the US government.

2. Their decisions are binding on US physicians.

3. They are politically independent.

The Task Force is a politically independent private-sector panel of experts in prevention and primary care.

They were founded in 1984 by the US Public Health Service. Since 1988, they have been sponsored by the Agency for Healthcare Research and Quality.  The Task Force reviews scientific evidence, estimates the magnitude of benefits and harms for each preventive service, reaches consensus about the net benefit for each preventive service, and issues a recommendation.

Their guidelines are not binding. The Task Force is focused on prevention and early detection of disease. Their recommendations are for screening examinations such as colonoscopy, vision, blood pressure and cholesterol. The Task Force convenes periodically to formulate and revise clinical guidelines which can be viewed at www.ahrq.gov.

Last week when they announced their revised guidelines for screening mammograms they caught the attention of many groups including American Cancer Society, Susan G. Komen Foundation and the American College of Obstetricians and Gynecologists. All expressed deep concern about the new recommendations.

Screening mammograms are used to detect breast cancer in those without any symptoms or clinical abnormalities. Mammography does not detect all breast cancers.  Some women have breast surgery based on mammogram findings only to learn, with great relief, that they do not have cancer.

This is an emotional roller-coaster and physically painful. Better methods of detection, involving new imaging and laboratory technologies are needed.

Although heart disease kills more women than breast cancer, it is cancer which is most feared. Studies indicate that, in general, women accept the limitations and risks of mammography, including the possibility of biopsy of normal breast tissue. 

The new guidelines from the USPSTF are for screening mammogram at age 50 and every 2 years thereafter until age 74. Expert panels from ACS and ACOG recommend annual screening mammography and clinical breast examinations beginning at age 40 (happy birthday!).

It takes about 1,900 screening mammograms among those between ages 40-49 to save one life. It takes about 1,300 screening mammograms in those 50 and older to save one life. 

The best recommendation put forth by all groups: the Task Force, ACS, Komen and ACOG, is for there to be discussions between a physician and a woman regarding what is best for her. On that we all agree.



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