Wake Radiology Response to United States Preventative Services Task Force (USPSTF) Recommendations 

December 2009  

On November 16, 2009 the U.S. Preventive Services Task Force (USPSTF) released new mammography screening guidelines. The USPSTF recommendations include increasing mammograms to once every two years between the ages of 50 and 74 and discontinuing monthly breast self-exams for all women. 

The breast imaging specialists of Wake Radiology have carefully reviewed the data, and we respectfully disagree with the USPSTF findings that suggest that women not begin their yearly mammograms until after age 50. We believe that following these USPSTF recommendations in our community will lead to increased morbidity and mortality from breast cancer.

Wake Radiology’s mammographers overwhelmingly support the current American Cancer Society (ACS) and American College of Radiology (ACR) guidelines that recommend women have yearly mammograms from age 40 to 80, citing the vast majority of medical data validating these standards, along with the noted decrease in deaths from breast cancer in our country that has occurred over the past two decades since the current breast screening guidelines were adopted and followed.

We encourage women to be aware of their breast health, understand their risks, and continue to follow existing ACR/ACS (American Cancer Society) recommendations for routine screenings, including yearly screening mammography beginning at age 40 and continuation of self exams each month to detect changes in their breasts. We also advise these women to have a yearly clinical exam by their health care provider.

If the USPSTF recommendations are adopted by the government and insurance carriers, the reality is that more women will die each year from breast cancer. That is neither reasonable nor acceptable to any of us at Wake Radiology.

Private insurers in the United States are required by law in every state, except Utah, to pay for screening mammograms for women in their 40s. Congress also requires Medicare to pay for annual screening mammograms.

Currently, one-third of all American women do not undergo regular screenings and with this report, we fear that others will not be screened and many more lives will be lost to breast cancer. The failure of age-appropriate women — those 40 to 80 years of age — to undergo mammography costs lives. The USPSTF recommendations set the stage for women to have even less access to appropriate breast cancer detection tools. Our breast imaging radiologists are dedicated to fighting to ensure that all women have access to proper breast care.

Kerry E. Chandler, MD
Director of Women's Imaging
Wake Radiology 

Landmark Study Confirms Mammography Lowers Breast Cancer Death Rate in Women 40-49 by Nearly a Third

ACS recommendations for finding breast cancer early

The ACS recommends the following guidelines for finding breast cancer early in women without symptoms:

Mammogram: Women age 40 and older should have a screening mammogram every year and should keep on doing so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.

Clinical breast exam (CBE): Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, at least every 3 years. After age 40, women should have a breast exam by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts look and feel like.

Breast self-exam (BSE): BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any changes in how their breasts look or feel to a health expert right away.

Breast MRI (Breast Magnetic Resonance Imaging): For certain women at high risk for breast cancer, screening BMRI is recommended along with a yearly mammogram. It is not generally recommended as a screening tool by itself because it may miss some cancers that mammograms would find. MRI also costs more than mammograms. Most major insurance companies will likely pay for a screening MRI if a woman can be shown to be at high risk, but it’s not yet clear if all companies will do so. More details about BMRI can be found on cancer.org.

Research has shown that BSE plays a small role in finding breast cancer compared with finding a breast lump by chance or simply being aware of what is normal for each woman. If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes. But it’s OK not to do BSE or not to do it on a fixed schedule.

The goal, with or without BSE, is to see a doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.

Women at high risk: Women with a higher risk of breast cancer should talk with their doctor about the best screening plan for them. This might mean starting mammograms when they are younger, having extra screening tests (such as an MRI), or having exams more often.

Medicare, Medicaid, and most private health plans cover all or part of the cost of this test. Call us at 1-800-227-2345 for information about facilities in your area. Breast cancer testing is available to women without health insurance and women who don’t have coverage for breast cancer screening. It may be free or offered at very little cost through a special program called the National Breast and Cervical Cancer

Early Detection Program (NBCCEDP). Your state’s Department of Health will have details about this program. There is also a new program to help pay for breast cancer treatment for women in need. To learn more about these programs, you can contact the Centers for Disease Control and Prevention at 1-800-CDC INFO (1-800-232-4636) http://www.cdc.gov/cancer/nbccedp