An influential federal panel said that most women under 50 do not need routine mammograms - a direct contradiction to longstanding advice from doctors and cancer groups.
In addition, the U.S. Preventive Services Task Force said there's no evidence that breast self-exam leads to fewer deaths, and suggested that doctors quit teaching women how to conduct the examinations at home.
The recommendations drew immediate outrage from many researchers, doctors and patients, who cited personal experience that the screening methods caught otherwise undetected cancers and led to successful treatment. Most authorities have called for regular screenings after the age of 40.
Some questioned the timing of the recommendations, coming as lawmakers in Washington debate ways to save money in the nation's health care system, possibly by curbing procedures or treatments that have no scientific evidence of benefit.
"We know that lives are saved through early detection," said Gloria Scienski, executive director of the Charlotte chapter of Susan G. Komen for the Cure. "We do see women in the 40 to 49 age range whose cancers are caught very early and move into that 98 percent success rate. I would hate to see what would happen to those women if they weren't catching it early."
In the past five years, Charlotte-based Presbyterian Healthcare has treated 2,147 patients younger than 50 for breast cancer. That is more than 19 percent of the total breast cancer patients treated in the Presbyterian hospital system in that time period.
"We feel that even one life, let alone 2,147 lives, is too important to lose because of lack of early detection," said Dr. Richard Reiling, medical director of the Presbyterian cancer center.
"This makes no sense to me," said Dr. Etta Pisano, a mammography researcher at UNC Chapel Hill who published an influential national study in 2005 that prompted wider use of newer, digital mammography technology. "I am tired of the debate over this. There is plenty of evidence that mammography reduces breast cancer mortality."
Pisano cited studies showing that even mammogram screenings done by older technology reduce death rates by at least 15 percent for women in their 40s.
But the task force looked at larger population studies and concluded that the evidence of benefit isn't convincing in the younger age group, particularly when weighed against the potential harm of false alarms, unnecessary radiation exposures and caustic treatments for relatively non-aggressive cancers.
"Although false-positive test results, overdiagnosis and unnecessary earlier treatments are problems for all age groups, false-positive results are more common for women aged 40-49 years," the task force reported.
The task force, a panel of public health doctors and academic medical center experts in prevention and primary care, has issued guidelines since it was formed in 1984. Its recommendations have helped frame advice issued by professional societies, health organizations, and medical quality review groups.
But the current findings are meeting strong resistance. The American Cancer Society, which has its own screening recommendations, issued a statement reaffirming its call for women to begin regular mammography at age 40.
Possibility of confusion
Dr. Gary Lyman, director of health services outcome research at Duke University Medical Center and a member of other medical panels that have set screening guidelines, said he fears that women will be confused about the conflicting recommendations.
Already, Lyman said, prevention efforts are flagging, so a mixed message could further erode progress.
"Women out of sheer confusion or uncertainty will not do routine mammography," he said, noting that early detection has long been a proven life-saver. Cancers that are caught early, before they spread, are easier to treat and can often be wiped out.
Lyman and other doctors questioned the motivation of the task force, because one of the topics in the national health care debate is the cost of unnecessary treatments and scans.
"In the future, as a society, we have to talk about resources," said Dr. Lisa Tolnitch, a surgeon in Raleigh who specializes in breast cancer. "Can you in a dollar-and-cents way prove you save lives? That's a hard thing to pin down. Then you have to say how much is a life worth? ... If it's your life, it's worth a lot to you."
The task force's findings, published in the Annals of Internal Medicine, have precedent. In Europe and Canada, screenings for most women are not started until after 50.
Dr. Amy Abernethy, director of the Duke Comprehensive Cancer Care Research Program, said she applauds the task force for a recommendation based on evidence, not emotion. She said she worked in Australia, and women there were unperturbed by the recommendation to begin mammograms after age 50.
Julie Doyle, who was diagnosed in May at the age of 43, said her breast cancer was detected by a routine mammogram.
"I felt no lump, nothing," said Doyle, a nurse who lives in Wake Forest. She had a mastectomy, plus chemotherapy. "I am the poster child for routine mammogram."