Doctors still divided on mammograms

It's been three years since the U.S. Preventive Services Task Force launched the mammography wars with its controversial recommendation that most women get fewer of the breast cancer screening exams — one every other year between the ages of 50 and 74.

The task force emphasized that routine mammograms catch three kinds of cancers: those that are too aggressive to be cured, those that could become deadly but are caught early enough to be treated and those that would never cause any harm. Only women with cancers in the second category benefit from screenings; meanwhile, widespread annual testing brings real harm in the form of false-positive test results and unnecessary treatment.

But many people protested, especially women who believe their lives were saved by screening mammograms that caught treatable cancers when they were in their 40s. The American Cancer Society continues to advise women to get screenings annually beginning at age 40 and for as long as they are healthy.

Last year, the New England Journal of Medicine published three viewpoints about mammograms. One of them endorsed the American Cancer Society's viewpoint, another endorsed the task force's recommendations and a third (by an epidemiologist and cancer surgeon in Norway) argued that routine screenings should be done away with altogether.

Recently, the journal published the results of an online poll to see which argument doctors found most persuasive. Among the 1,240 who voted, the strategy with the most support was the one backed by the task force. Fully 44 percent of those surveyed backed screening starting at age 50, while 39 percent sided with the American Cancer Society and 17 percent were ready to do away with screening mammograms.

The task force approach was most popular in North America, with backing from 47 percent of respondents. Support for the Cancer Society guidelines was strongest in Central and South America, where 58 percent of doctors agreed that screening mammograms should begin at age 40. The idea that asymptomatic women should skip mammograms altogether was most popular in Europe (27 percent).

Even on an issue as contentious as this, there is still some common ground, the researchers wrote: "There is widespread agreement that mammography is a flawed screening instrument, because it detects lesions that are not cancer and can miss malignant lesions."

Los Angeles Times