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New Canadian Guidelines Also Support No Routine Mammograms Until 50
Date:11/21/2011

vre, 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 guidelines.

"These are ridiculous reco
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