Task Force Responds to Mammogram Controversy
Panel member defends recommendations, says point was to inform women.
Nov. 19, 2009— -- A member of the panel that unleashed a firestorm of controversy when it recommended a change in the age and frequency at which women should get mammograms today answered critics' claims that the new recommendations could prove harmful to women.
"This is not a recommendation to not screen. It's a recommendation to provide women with the facts," Dr. Timothy Wilt , a member of the U.S. Preventive Services Task Force, told "Good Morning America." "Our recommendations support an individualized decision-making process with the women so that they have knowledge about the risks and benefits associated with mammography screening."
The recommendations, issued Monday, suggested among other things, that women between the ages of 40 and 49 should not necessarily get regular breast cancer screenings and that 50- to 59-year-old women should have them every two years instead of every year, as the American Cancer Society recommends.
Since the recommendations were published Monday the panel has come under fire from critics, some of whom claim the new guidelines were influenced by insurance and health care costs, and that they were based on a single study. Wilt denied both allegations.
"Cost is not considered at all. This is about providing high-quality health care for the individual [and] providing the information they need to know to make an informed decision," he said. "The information is based on eight very large, randomized, controlled trials of mammograms in women, a series of six different databases and a variety of other studies."
Wilt said that according to the task force's research, the benefits of saving about one life out of every 2,000 through mammograms for women between the ages of 40-49 "needs to be balanced" with the sometimes serious harms that come with incorrect treatment and overtreatment.
"We place great value in being able to reduce a death occurrence in breast cancer, [but] that occurs very rarely -- one in about 2,000. The other 1,999 wouldn't benefit," Wilt said. "Up to 30 percent of breast cancers would never progress to the point that they would ever be noticed in a woman's lifetime. We often treat those. They may be unnecessary treatments [resulting in] pain and disfigurement from surgery.
"Those harms that occur with many women need to be balanced out with the benefits for a few," he said.
Unnecessary treatment was also a concern to the panel when it suggested women should not be taught to perform breast self-exams, Wilt said.
"There have been several large, well-designed trials that have looked at teaching breast self-exam. Women who did more breast self-exams, did more high-quality exams, found more lumps, had more biopsies, had more breast cancer surgeries," Wilt said.
But, according to Wilt, the heightened self-testing "did not have a reduction in breast cancer mortality."
"Not to say that if a woman doesn't feel a lump she shouldn't bring it to the attention of her physician," he added.
Wilt's comments come the day after Health and Human Services Secretary Kathleen Sebelius defended the panel's methods but clarified the guidelines as recommendations, not policy.
"The United States Preventative Service Task Force have done what they've been asked to do, which is routinely review data and look at preventive services across the board and make recommendations," Sebelius said. "They don't make policy. Do what you have always done. Figure out your own health situation with your doctor, your family history. Those are really the important ingredients."
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