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U.S. Preventive Services Task Force revises its earlier recommendations on mammography

On February 21, HHS Secretary Tommy G. Thompson released an updated recommendation from the U.S. Preventive Services Task Force (USPSTF) that calls for screening mammography, with or without clinical breast examination, every 1 to 2 years for women ages 40 and over. This recommendation affirms HHS' existing position on the value of mammography and also echoes the position of the National Cancer Institute on use of mammography to screen for breast cancer.

The USPSTF published two earlier breast cancer screening recommendations, in 1989 and 1996, that both endorsed mammography for women over age 50. The Task Force is now extending that recommendation to all women over age 40, but as they point out, the strongest evidence of benefit and reduced mortality from breast cancer is among women ages 50-69. The recommendation acknowledges that there are some risks associated with mammography (false-positive results that lead to unnecessary biopsies or surgery), but that these risks lessen as women get older.

Breast cancer is the most common cancer among women in the United States. In 2001, an estimated 192,200 women were diagnosed with breast cancer, and 40,600 women died from the disease. In addition to age, other factors may increase a woman's risk of breast cancer. The strongest risk factors are a family history of breast cancer in a mother or sister, having already been diagnosed with breast cancer, or having had a previous breast biopsy showing atypical hyperplasia (an irregular pattern of cell growth).

The new USPSTF recommendation results largely from the review of eight randomized controlled trials of mammography (four of mammography alone and four of mammography plus clinical breast examination) that have reported findings with 11 to 20 years of followup. These studies have all been published since the Task Force last addressed this issue in 1996.

The USPSTF also noted that there continues to be insufficient evidence to recommend for or against routine clinical breast examination alone as a screening tool for breast cancer. In addition, there is insufficient evidence to recommend for or against teaching or performing routine breast self-examination. While these techniques detect some additional cancers, there were not enough data to determine whether they reduced deaths from breast cancer.

The USPSTF, the leading, independent panel of private-sector experts in prevention and primary care, is sponsored by the Agency for Healthcare Research and Quality. The Task Force conducts rigorous, impartial assessments of scientific evidence for a broad range of preventive services.

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