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Johns Hopkins Children’s Center cardiologist Anne Murphy takes issue with the ongoing breast-cancer screening Controversy in a Jan. 13 commentary in JAMA.

Under Murphy’s editorial microscope: The newly amended—and highly contentious—breast cancer screening guidelines from the U.S. Preventive Services Task Force (USPSTF). Released in November, the guidelines recommend against universal annual mammograms for women beginning at age 40. The new guidelines are based, in part, on concerns about false positive results, unnecessary biopsy and treatment and radiation exposure.

Many breast cancer survivors and advocacy organizations oppose the guidelines.

“Both camps bring up valid points but there is a middle-of-the-road approach that combines the best interests of both sides and that can guide our decisions as physicians and patients,” Murphy says.

The new guidelines, she says, could and should create an opportunity for individualized care, not one-size-fits-all medicine.

Individualized care: First and foremost, Murphy says, physicians and patients must talk honestly and openly about the benefits and risks of mammography, an imperfect test that can lead to false positives, especially in younger women, causing more aggressive tests, invasive biopsies and unnecessary anxiety. If a careful individualized assessment by the physician reveals risk factors, a screening mammogram may be warranted even in symptom-free patients under 50. Primary-care providers must inquire about family history of cancers on both sides of the family because breast and ovarian cancer genes may be inherited through the father, Murphy says.

False alarms: To minimize the harmful effects of false positives, Murphy recommends referring younger women to breast-imaging centers that offer digital mammography. Patients with suspicious findings can typically undergo minimally invasive core-needle biopsies, instead of traditional surgical biopsies.

Insurance implications: Policy makers should create stipulations to prevent insurers from denying payment for testing in younger women.

More research: Murphy calls for funding geared toward more accurate screening tests and improved early diagnosis.

Source: Johns Hopkins Children’s Center

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