By STEPHANIE NANO and MARILYNN MARCHIONE, Associated Press Writers

NEW YORK (AP) -- Most women should wait until age 50 to get mammograms and then have one every two years, a government task force said Monday in a major reversal that conflicts with the American Cancer Society's long-standing recommendation of annual screening starting at 40.

Also, the task force said breast self-exams do no good and women shouldn't be taught to do them.

For nearly two decades, the cancer society has been recommending regular mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women's odds of surviving the disease.

"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies. But Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group, said insurance coverage isn't likely to change because of the new guidelines.

Making Sense of New Mammography Recommendations

I am not in favor of the new guidelines. Not sure what I wrote that would communicate that message. Sorry, if my message was unclear.

Hello all,

I have been reading this thread over the last few days and there are some things that I want to point out that are being overlooked.  First let me say that I do not agree with the guidelines, but a lot of things are being said that are not true and there is a lot of misinterpretation.  First of all, the USPTSF is a VERY conservative government group which has always made recommendations that were much less aggressive (and less expensive) than other groups.  For instance, it was not until 2008 that the USPTSF added colonoscopy to their recommended list, but they still list it as equal (at best) to fecal occult blood testing.  They are against using PSA or digital rectal exam to check for prostate cancer, saying that the evidence is insufficient.  They are against routine screening for thyroid disease, as well as for diabetes unless the person has a sustained blood pressure over 135/85.  They evaluate the evidence, and unless there are good studies, preferably randomized, the evidence is considered to be less than ideal.  Not that they are wrong, but those kinds of studies are expensive and hard to come by.  So remember that ALL the recommendations from this group tend to be very conservative.  For a link to their guidelines   for various screenings and counseling, the site is here: http://www.ahrq.gov/Clinic/cps3dix.htm - http://www.ahrq.gov/Clinic/cps3dix.htm    

It took me a while to find the USPSTF old guidelines (from 2002), but I did, and they are as follows: 

The http://www.ahrq.gov/clinic/uspstfix.htm - (USPSTF) recommends screening mammography, with or without clinical breast examination, every 1-2 years for women aged 40 and older.

Dear Marie,

Thank-you - This is very informative and interesting in the fact the committee appears to find less importance in diagnostic screening overall. After listening to Secretary Sibelius lack of support of the committee findings I was curious as to what the purpose is of the committee if the findings are not supported by HHS.

I went to the HHS website to find the purpose of the committee and found the following:

Impact of the USPSTF Recommendations:

USPSTF recommendations have formed the basis of the clinical standards for many professional societies, health organizations, and medical quality review groups. Previous editions of the Guide to Clinical Preventive Services have been used widely in undergraduate and post-graduate medical and nursing education as a key reference for teaching preventive care.

The work of the USPSTF has helped establish the importance of including prevention in primary health care, ensuring insurance coverage for effective preventive services, and holding providers and health care systems accountable for delivering effective care.

USPSTF recommendations highlight the opportunities for improving delivery of effective services and have helped others in narrowing gaps in the provision of preventive care in different populations.

I just saw Blue Cross/Blue Shield's Statement:

USPSTF Mammography Recommendations Will Result in Countless Unnecessary Breast Cancer Deaths Each Year

Nov. 16, 2009 — If cost-cutting U.S. Preventive Services Task Force (USPSTF) mammography recommendations are adopted as policy, two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year. The recommendations ─ created by a federal government-funded committee with no medical imaging representation ─ would advise against regular mammography screening for women 40-49 years of age, provide mammograms only every other year for women between 50 and 74, and stop all breast cancer screening in women over 74.

“These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives ─ including in women aged 40-49. These new recommendations seem to reflect a conscious decision to ration care. If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women,” said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission.

Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent. Ignoring direct scientific evidence from large clinical trials, the USPSTF based their recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50.  In truth, there are no data to support this premise.

“The USPSTF claims that the “harms” of mammography, including discomfort of the exam, anxiety over positive results, and possibility of overtreatment because medical science cannot distinguish which cancers will become deadly most quickly ─ outweigh the greatly decreased number of deaths each year resulting from breast cancer screening. Without doubt, the possibility of having one’s life saved through early detection far outweighs any of these concerns. Their premise is tragically incorrect and will result in many needless deaths if their recommendations are adopted by the American public.” said Lee.

"The USPSTF recommendations are a step backward and represent a significant harm to women's health. To tell women they should not get regular mammograms starting at 40 when this approach has overwhelmingly been shown to save lives is shocking. At least 40 percent of the patient years of life saved by mammographic screening are of women aged 40-49. These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs. Unfortunately, many women may pay for this unsound approach with their lives," said W. Phil Evans, M.D., FACR, president of the Society of Breast Imaging (SBI).

The USPSTF is an independent panel of primary care physicians funded and staffed by the HHS Agency for Healthcare Research and Quality (AHRQ). The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gave HHS the authority to consider USPSTF recommendations in Medicare coverage determinations for additional preventive services. Recently, Congress has expressed their desire to broaden this authority and enhance the role of the USPSTF in terms of its impact on coverage for existing services. Additionally, private insurers may incorporate the AHRQ-funded USPSTF recommendations as a cost-savings measure.

“I am deeply concerned about the actions of the USPSTF in severely limiting screening for breast cancer. These recommendations, in combination with recent CMS imaging cuts, jeopardize access to both long proven and cutting-edge diagnostic imaging technologies. Government policy makers need to consider the consequences of such decisions. I can’t help but think that we are moving toward a new health care rationing policy that will turn back the clock on medicine for decades and needlessly reverse advances in cancer detection that have saved countless lives,” said James H. Thrall, M.D., FACR, chair of the American College of Radiology Board of Chancellors

I feel alot better now.  I feel optomistic that nothing will change.  The supporters of the new guidelines are in minority, and I think our voices and the voices of the medical experts (not primary doctors) will be heard louder than the task force, Susan Love, and Fran Visco. My hope and expectation is that the majority will still have some say over what hapens with federal programs.  I could be naive but I am unwilling to partake in a political debate.  Too stressful.