Misplaced Outrage – The New Breast Cancer Screening Guidelines

Outraged breast cancer survivors were heard loud and clear this past week – they weren’t happy with the new breast cancer screening guidelines.  But why the outrage against guidelines based on evidence and science?  Because of deeply held beliefs that have been rigorously promoted and marketed for financial gain. You can’t get out of the grocery store in October without hearing the message – early detection saves lives.

The truth is all breast cancers are not the same, and we don’t have the tools to detect the lethal ones early enough.  Some breast cancers are slow-growing and won’t be lethal, whether found small or large.  Others are aggressive, and fast-growing, and lay the groundwork for metastasis, or spread to other parts of the body, before any of our methods can detect these cancers.

A woman who found a cancer in her 40s by a mammogram can’t know if it saved her life.  She could have found it a year later while getting dressed, and if her cancer is responsive to treatment, would have had the same prognosis.  Or, she could have had a slow-growing tumor that would never have been life threatening.  Or, stray tumor cells may be lying dormant to reappear in five or ten years and still be life threatening.  We can’t know the truth about breast cancer and the effectiveness of screening and treatments by relying on stories and beliefs.  The only way to get to truth is to follow the evidence, the large, randomized, clinical trials of hundreds of thousands of women.

That’s what the Task Force did.  They systematically reviewed all relevant, clinical trials on mammography and breast self exam. After a thorough review of clinical trials and statistical models on risks vs. benefits, they concluded:

To recommend against screening mammography in women aged 40-49

To recommend  every other year screening for women aged 50 to 74

To recommend against teaching breast self examination.

The new guidelines really aren’t so shocking.  The American College of Physicians made similar recommendations a few years ago.  An NIH consensus panel came to similar conclusions in the 90s, but politicians got involved and the consensus panel was overruled by the Senate.  The National Breast Cancer Coalition has been saying for over ten years that we don’t have good evidence to support broad public health policy on breast cancer screening.  NBCC has always said that women deserve the facts, and should have the freedom to make their own decisions regarding screening.

So why the outrage at a panel of prevention experts?  Why not outrage at all those institutions that promoted a simple but false message for financial gain?  Why not outrage that we could have made more progress over the last twenty years if we hadn’t accepted faulty screening as our answer to this disease?  Why not outrage that 40,000 women keep dying of this disease every year?

Maybe, just maybe, this firestorm over the new guidelines will expose the deeply ingrained falsehoods about breast cancer and screening, and allow us to move forward and push for the screening and diagnostic tools that will work, and finally make some progress in eradicating this disease.

Change and progress are often messy and painful, but if we get where we need to go in the end, it will all be well worth it.

To learn more about the guidelines and the science behind them, read NBCC’s analysis.

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