According to the United States Preventive Services Task Force (USPSTF) study introducing Mammography screening test to 40-49 year olds have clearly shown to reduce the mortality due to breast cancer. But there is an issue of high incidence of false positives among this age group (97.8 per 100 women per screening round as opposed for the 40-49 age group as opposed to 86.6 per 100 women per screening round). These false positives have not lead to a subsequent increase in over diagnosis. The incidence of over diagnosis is greater among the older age group. The argument of false positives as a reason for revising the guidelines is pointless. Since mammography is clearly a screening test and previous studies have over and again shown that, the benefits clearly outweigh the risks.
The anxiety and distress to the patient were variable after a false positive result. There was no significant increase in general anxiety levels of the patient after a false positive result, though there was a reported increase in the breast cancer specific anxiety levels.
The study states there is a higher Number needed to Invite (NNI) for the 39-49 age group standing at 1904, in order to prevent single breast cancer mortality as opposed to NNI of 1339 for the 50-59 age group. But if you compare the relative risk of breast cancer mortality for the 39-49 age group with the 50-59 age group, there is minimal difference of 0.85 vs 0.86. If this is the criteria used for revision of the guidelines, then it is a reflection of efforts to stand in line with the health care reforms of the US President rather than taking care of the benefits of the patients.
Even though the screening detected invasive breast carcinoma is the least for 40-49 age group. For 1000 women per screening round, the detection of invasive carcinoma is 1.8, the USPSTF is very clear on the benefits of screening mammography in patients of 40-49 age groups, and clearly states that even though the patients in the 40-49 age group experience a greater number of false positives; this does not reduce the life saving benefits of the screening test. The meta analysis of the data used for the new recommendations reveals that the screening trials indicates breast cancer mortality benefit for all age groups from 39 to 69 years.
The USPSTF study is very specific about the additional diagnostic tools being used after a positive screening mammography result. The 40-49 age group has the highest rates of additional imaging modalities (84.3 per 1000 women per screening round) though this age group has the least biopsy rates (9.3 per 1000 women per screening round). The argument of the patient having forced to undergo painful and complicated procedures, is refuted by the USPSTF study themselves,.
In conclusion the USPSTF study on the basis of which the revised guidelines for mammography has been devised is paradoxical, and the revision is a clear indication stating that the USPSTF are more concerned about additional health costs incurred rather than putting the welfare of the patient first. The USPSTF has acted highly irresponsible towards the entire medical fraternity. Instead of working towards increasing the number of patients of 39-69 age group undergoing mammography screening, they have created more confusion among the practitioners as well as new problems for the patients. Many of the 40-49 age group women who will undergo mammography screening in the US will now stand at a risky corner with health insurance not covering the cost required for the procedure, eventually increasing the financial burden on a health care seeking US family.
Disclosure: I am not a physician based in the US. I have no other conflict of interest.