Mammogram Recommendations Draw Widespread Anger

"[Some] women don't understand how screening can cause problems," said Dr. Bob Crittenden, an associate professor in family medicine at the University of Washington. "Personally, I think this is symptomatic of many in people in medicine promising good health if you get screened. As we know with PSAs and other screenings of asymptomatic people, we have only a few things we can do that actually help extend life and then usually only marginally."

Crittenden explained that in his own practice, patients are screened if they would like before age 50 and screenings are strongly encouraged after that age.

Several family doctors contacted by ABC News said the recommendations reflect some of the sentiment against screenings because of the possibility of unnecessary treatments, and expressed hopes that they will lead to more open conversations about mammograms and cancer screening with patients.

Sources of Medical Opposition

Dr. Gary Lyman, a breast cancer oncologist at Duke University who researches comparative effectiveness, says guidelines like those issued by the USPSTF may cause a great deal of harm.

"This is a reversal of the position they took in their previous recommendations, and this flies in the face of previous guidelines from other groups in the U.S.," he said. "[While] the risk of breast cancer is less in the younger age group, 40 to 50, mammograms save lives in those age groups."

Lyman said his primary criticism is that in between the last set of screening guidelines in 2002 and the current ones, only one study has come out in the area, and it did nothing to change what doctors know about mammograms.

"I'm puzzled why, when the evidence hasn't really changed, when the estimate in benefit and risk hasn't really changed, why they reversed their position," he said.

Lyman said he was also worried about potential confusion among women over 50, since under the new guidelines they are being told to get screened every other year, while previously they had been told to get screened every year.

"I don't know if we know that's going to cause harm or not," he said. "What I'm worried about the most, however, is confusion on the part of women and their physicians that may make them question whether mammograms will do anything."

His concerns were borne out in at least one New York hospital on Tuesday.

"I spoke to our breast imaging department today and they said that the 'no-show' rate doubled today," said Dr. Susan K. Boolbol, the Chief of Breast Surgery at Beth Israel Medical Center in New York. "That means that twice as many patients today decided not to show for their mammogram appointment. That is a very concerning rate. We will monitor this to see if it continues."

But Boolbol said she is also concerned that "controversies such as these really create a feeling of mistrust for the medical community at large."

Lyman said the benefits of mammography have been clear, particularly since insurers and Medicare began reimbursing for them, noting that mortality rates have fallen by 25 percent since then.

"I can't say all that's due to mammography, but it's pretty clear that part of that and maybe most of that is due to early detection with routine mammographic screening," he said.

But he agrees with Boolbol about the potential for mistrust, noting that screening rates have fallen in the past few years.

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