ABC News Doctors Sound Off on New Mammogram Recs

Nov. 18, 2009— -- What will the new recommendations by a government panel on mammography mean for women? How will these guidelines affect insurance coverage of breast cancer screening? And should women look to alternatives to mammography to detect breast cancer in its early stages?

Such are the questions that have followed updated recommendations on mammography issued Monday evening by the United States Preventive Services Task Force recommending against annual mammograms for women between the ages of 40 and 49 and spacing them out for older women, saying the risks outweigh the benefits.

To get answers to these questions, Good Morning America consulted its medical team – ABC News Chief Medical Editor Dr. Timothy Johnson, ABC News Senior Health and Medical Editor Dr. Richard Besser, and ABC News Medical Contributor Dr. Marie Savard.

What all three doctors said was that the updated recommendations, while they may be well-intentioned, raise significant concerns – and that women, at least for the time being, should adhere to prior guidelines.

"I was so surprised about these recommendations," Savard said. "I think women should stay put in terms of what they're doing."

Johnson said that a question that naturally accompanies such a change concerns alternatives to mammography – of which, he said, there are currently no good ones.

"Right now, screening mammogram is the best tool we have," he said. "That's why we recommend it."

And Besser said that in terms of lives saved – 1 in 1,300 for women 50 and over, one in 1,900 for women 40-49 – he does not believe there is enough difference in benefit between these groups to warrant a difference in recommendations.

Meanwhile, the American Cancer Society and the American College of Obstetrics and Gynecology are among the many groups that supported the old guidelines and have stood firmly by them since the USPSTF released its new recommendations.

"When you see two prestigious bodies, this task force and the American Cancer Society, looking at the same information and coming up with wholesale different conclusions, that raises red flags for me in saying, 'Okay, smart people can disagree; let's not do anything rash before these are looked at in great detail.'"

It's not just professional organizations who are bucking the new guidelines. Since they were issued on Monday, the changes in recommendations have met a groundswell of rejection from many medical centers, breast cancer survivors and numerous doctors -- some of whom have advised their patients to ignore the recommendation.

According to most medical centers that ABC News has heard from, the new screening guidelines will not be followed. M.D. Anderson, the Mayo Clinic, Baylor, Beth Israel Deaconess Medical Center and Fox Chase Cancer Center were among many hospitals that said they are sticking with the current guidelines, recommended by the American Cancer Society.

USPSTF has defended their rationale for the change. Dr. Diana Petitti, vice chair of USPSTF, said the task force reviewed a number of studies to compile the benefits of mammograms, such as how many cancers were detected and how many lives were saved, and the harms of mammograms, such as how many false positives popped up, how many unnecessary tests were done and how much extra radiation women were exposed to during the false positive testing.

The task force then did calculations and mathematical models to see how these benefits and "harms" would change if women started getting routine mammograms at different ages and different intervals.

The recommendations are also only for women considered to be at normal risk for breast cancer. Women who are at a known high risk -- for instance, women who tested positive for the BRCA-1 and BRCA-2 genes -- would not fall under the guidelines.

In recent months, some sentiment has arisen opposing increased screening. A study released in September brought to light some of the potential risks of a false positive. While efforts have been made to increase cancer screening, many patients are unaware of the potential consequences of a false positive, including unnecessary anxiety, testing and possibly treatment.

"[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 on request 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.