HHS Secretary Supports Mammogram Screening

WASHINGTON—Amid continuing controversy over the effectiveness of screening mammography for breast cancer, the US Preventive Services Task Force (USPSTF) has extended its recommendations to include women between the ages of 40 and 49, after concluding that the procedure reduces breast cancer deaths.

In previous screening recommendations issued in 1989 and 1996, the panel had endorsed mammography for women age 50 and older. Its new report received added emphasis because it was released personally and strongly supported by Tommy G. Thompson, secretary of Health and Human Services (HHS).

"When it comes to mammography, the federal government’s recommendation remains very clear: Women in their 40s and older should be screened every 1 to 2 years with mammography," said Secretary Thompson, whose wife Sue Ann was diagnosed with breast cancer 7 years ago following her yearly mammogram.

The HHS secretary acknowledged critics’ arguments that the screening procedure is not perfect and that false positives do cause anxiety in women. "But mammography is an important and effective early detection tool that does help to save lives. We want women to understand this point very clearly," he said.

The USPSTF is an independent panel of nongovernment experts in prevention and primary care that assesses scientific evidence and makes recommendations across a broad spectrum of preventive services. It is funded by the Agency for Healthcare Research and Quality (AHRQ), a part of HHS.

The panel’s new mammography recommendations follow a review of eight randomized controlled trials, four of mammography alone and four of mammography plus clinical breast examination. The reports include follow-up results of 11 to 20 years, and all of them have been published since USPSTF issued its last recommendations on the screening process.

"We acknowledge that the clinical trials are flawed and they are not perfect . . . but the task force concluded that the studies are still valid and that mammography screening reduces deaths from breast cancer," said Janet Allen, PhD, RN, USPSTF vice chair. "We based our recommendations on the overall quality of the studies or the evidence."

While the panel found evidence supporting the use of mammography in women in their 40s, the panel said the strongest evidence of benefit and reduced mortality is among women age 50 to 69. Its recommendation echoes that of the National Cancer Institute in advising women age 40 to 49 to get a screening mammogram ever year or two.

The USPSTF breast cancer screening recommendations and materials for clinicians and patients are available on the Web at http://www.ahrq.gov/clinic/3rduspstf/breastcancer/ or by calling AHRQ’s toll-free information clearinghouse at 1-800-358-9295.