New Canadian Guidelines Also Support No Routine
Mammograms Until 5011/21/11
MONDAY, Nov. 21 (HealthDay News) -- The Canadian Task Force on
Preventive Health Care on Monday issued new recommendations on
breast cancer screening, and they're similar to controversial
guidelines issued in 2009 by a U.S. governmental panel.
As the U.S. Preventive Services Task Force (USPSTF) recommended
two years ago, the government-appointed Canadian panel of experts
is also suggesting that women aged 40 to 49 who are at average risk
for breast cancer
not get routine mammograms.
The Canadian task force has also dropped recommendations for
breast self-exams and clinical exams for women with no
The new guidelines, replacing those issued in 2001, are for
women at average risk of breast cancer only. The new guidelines
also recommend longer mammogram screening intervals for women aged
50 to 74 -- to once every two or three years. Previous guidelines
had recommended mammograms once every two years for women aged 50
to 69 and did not address women aged 70 to 74.
The earlier guidelines had said women between 40 and 49 could be
screened, but they were not to be actively recruited for screening,
noted Patrice Lindsay, an expert in "best practices" for medical
care and an appointed member of the Canadian task force.
According to Lindsay, "there has been a considerable amount of
evidence out over the past few years looking at the benefits and
harms of screening practices. The evidence really doesn't support
more frequent screening in terms of having an impact on the
outcome." The outcomes considered, she said, are a diagnosis of
breast cancer and breast cancer death.
The guidelines are published Nov. 21 in the
Canadian Medical Association Journal.
The new guidelines may rekindle the debate on mammography among
experts in the United States.
"I believe the U.S. and Canada recommendations have much in common," said Dr. Michael LeFevre, co-vice chair of the USPSTF and vice chair of family and community medicine at the University of Missouri, in Columbia.
In 2009, the USPSTF recommended every-other-year mammograms for
women aged 50 to 74. They advised women under 50 to discuss the
test with their doctor and only then decide whether to get a
mammogram, based on patient preference and other factors. They also
recommended against teaching breast self-exam. The USPSTF said
evidence was insufficient to assess the benefits and harms of doing
clinical breast exams in women aged 40 and older.
LeFevre believes that both panels' recommendations hinge on a
balancing of risks and benefits to women. Benefits include finding
tumors early; harms include the risk for a false-positive test and
then unnecessary worry and over-treatment.
"Both Canada and the U.S. recommendations recommend regular screenings for women 50 to 74, although the U.S. task force recommends every two years and theirs [Canada's] provides the option of every two or three," LeFevre said.
"The [U.S.] task force assessment for those 40 to 49 was that the benefits do outweigh the harms but only by a small amount, and the decision must be weighed individually," LeFevre said.
Not everyone agrees with the USPSTF on that assessment, however.
The American Cancer Society, for example, continues to recommend
annual mammograms beginning at age 40.
In a commentary that accompanies the Canadian guidelines, Dr.
Peter Gotzsche of Copenhagen contends that, "The best method we
have to reduce the risk of breast cancer is to stop the screening
programs." He focused on the problem of "overdiagnosis," defined as
treating a cancer that would never have caused problems in a
patient's lifetime. Gotzsche contends that the level of this type
of overdiagnosis in countries with organized screening programs is
now about 50 percent.
Other experts took a different view of the Canadian
"These are ridiculous recommendations," said Dr. Stamatia Destounis, a radiologist in Rochester, N.Y., and a managing partner at Elizabeth Wende Breast Care.
Among her criticisms, she said, is that doctors simply cannot
predict which of the women would have had a cancer that remained
harmless during her lifetime. As for not screening women aged 40 to
49, she said, "They are the moms, the worker bees, the women who
have several decades left of working, and we want to find these
things [tumors] as small as possible."
Still, the experts did agree on one piece of advice for women:
All women should discuss screening with their doctor to decide what
is best for them.
LeFevre said that when he talks to other U.S. doctors about
mammography screening, he tells them: "At age 40, discuss. At age
50, recommend or encourage. At age 60, strongly encourage."
To learn more about the U.S. panel's recommendations, head to
U.S. Preventive Services Task Force.
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