Soon the U.S. Preventive Services Task Force (USPSTF) will issue a new draft of recommendations for breast cancer screening in women. As outlined on its website, the AHRQ-appointed panel aims to “improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.”
2. O you who believe! Let
not the hatred of some people in (once) stopping you from Al-Masjid-al-Haram(at Makkah)
lead you to transgression (and hostility on your part). Help you one
another in Al-Birr and At-Taqwa(virtue, righteousness
and piety); but do not help one another in sin and transgression. And fear
Allah. Verily, Allah is Severe in punishment.
3. Forbidden to you (for
food) are: Al-Maytatah (the dead animals - cattle-beast
not slaughtered), blood, the flesh of swine, and the meat of that which has
been slaughtered as a sacrifice for others than Allah, or has been slaughtered
for idols, etc., or on which Allah's Name has not been mentioned while
slaughtering, and that which has been killed by strangling, or by a violent
blow, or by a headlong fall, or by the goring of horns - and that which has
been (partly) eaten by a wild animal - unless you are able to slaughter it
(before its death) - and that which is sacrificed (slaughtered) on An-Nusub (stone
altars). (Forbidden) also is to use arrows seeking luck or decision, (all)
that is Fisqun (disobedience of Allah and
sin). This day, those who disbelieved have given up all hope of your
religion, so fear them not, but fear Me. This day, I have perfected your
religion for you, completed My Favour upon you, and have chosen for you Islam
as your religion. But as for him who is forced by severe hunger, with no
inclination to sin (such can eat these above-mentioned meats), then surely,
Allah is Oft-Forgiving, Most Merciful. 5. Surah Al-Ma'idah (The Table
Spread with Food)
When the panel last published a draft of new breast cancer screening guidelines in November 2009, an uproar followed. The key USPSTF changes, published in the Annals of Internal Medicine, included a recommendation against routine screening mammography for women aged 40 to 49 years. For women between the ages of 50 and 74, biennial screening was advised.
So who are the current USPSTF panel members who will issue the new breast cancer screening recommendations? The roster lists 16 individuals. It includes 13 physicians (MDs), 2 nurses (RNs) and one clinical psychologist.
The two co-chairs, Drs. Michael LeFevre and Albert Siu, are both accomplished physicians who hold MSPH (Master of Science in Public Health) degrees. LeFevre, a member of the Institute of Medicine, is a practitioner of family medicine and professor in the Department of Family and Community Medicine at the University of Missouri. Siu is a geriatrician and professor who chairs the Department of Geriatrics and Palliative Medicine at New York’s Icahn School of Medicine at Mount Sinai.
It’s a bit like a jury of health care professionals who weigh the evidence on breast cancer screening. Among the 16 USPSTF members, 10 hold advanced degrees in public health (MPH). Several more have master degrees in fields having to do with statistics and clinical research methods.
Among the 13 physicians on the task force, the areas of expertise by clinical training include internal medicine (5), family practice (4), obstetrics and gynecology (2), pediatrics (1) and combined training in internal medicine and pediatrics (1). The USPSTF does not include an oncologist, a radiologist, a cancer surgeon, a pathologist or radiation oncologist – specialists who are typically involved in the diagnosis and care of women with breast cancer.
Some people say that clinical expertise shouldn’t matter in evaluating published results of trials and meta-analyses. But I think that at least one oncologist (or, better, a handful in a panel of 16 for breast cancer screening guidelines) and radiologist would offer insight – if not the last word – on the potential benefits, physical harms and costs of breast cancer screening by old-fashioned, digital or 3-D mammography, sonography, MRI and breast self-examination. Perhaps one of those specialists might point out and persuade the larger group of problems and limits to published evidence. An expert might notice something – a flaw in a study or benefit, untallied, that the other panelists don’t realize or fully appreciate.
About one in eight women in the UK are diagnosed with breast cancer during their lifetime. There's a good chance of recovery if it's detected in its early stages.
Breast screening aims to find breast cancers early. It uses an X-ray test called a mammogram that can spot cancers when they are too small to see or feel.
Breast screening does, however, have some risks you should be aware of (see below).
As the likelihood of getting breast cancer increases with age, all women who are aged 50-70 and registered with a GP are automatically invited for breast cancer screening every three years.
In the meantime, if you are worried about breast cancer symptoms, such as a lump or area of thickened tissue in a breast, don't wait to be offered screening – see your GP.
This page gives an overview of breast cancer screening, with links to information on why and when it is offered, what happens when you go for breast screening, and receiving your results.
Why is breast screening offered?
Most experts agree that regular breast screening is beneficial in identifying breast cancer early. The earlier the condition is found, the better the chances of surviving it.
You're also less likely to need a mastectomy (breast removal) orchemotherapy if breast cancer is detected at an early stage.
The main risk is that breast screening sometimes picks up cancers that may not have caused any symptoms or become life-threatening. You may end up having unnecessary extra tests and treatment.
When will I be offered breast screening?
Breast screening is currently offered to women aged 50-70 in England. However, the NHS is in the process of extending the programme as a trial, offering screening to some women aged 47-73.
You will first be invited for screening between your 50th and 53rd birthday, although in some areas you'll be invited from the age of 47 as part of the trial extension of the programme.
You may be eligible for breast screening before the age of 50 if you have a higher-than-average risk of developing breast cancer
If you're over the age of 70, you'll stop receiving screening invitations. However, you're still eligible for screening and can arrange an appointment by contacting your local screening unit.
What happens during breast screening?
Breast screening is carried out at special clinics or mobile breast screening units. The procedure is carried out by female members of staff who take mammograms.
During screening, your breasts will be X-rayed one at a time. The breast is placed on the X-ray machine and gently but firmly compressed with a clear plate. Two X-rays are taken of each breast at different angles.
When will I receive my results?
After your breasts have been X-rayed, the mammogram will be checked for any abnormalities. The results of the mammogram will be sent to you and your GP no later than two weeks after your appointment.
Following screening, about one in 25 women will be called back for further assessment. Being called back doesn't mean you definitely have cancer. The first mammogram may have been unclear.
About one in four women who are called back for further assessment are diagnosed with breast cancer.
Educating women about the possibility of "overdiagnosis" from mammography screening may make some of them less likely to get the test, a new study says.
One expert said the findings are important.
"The take-home message needs to be that women should be informed, not only of the benefits of mammography, but also of the shortcomings of the test," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City.
"In this way, they can make informed decisions about their health care," said Bernik, who was not involved in the study.
The risks and benefits of routine mammography continue to be debated. While some studies suggest that regular screening does save lives, other experts are concerned about the problem of overdiagnosis.
Over-detection and overdiagnosis means that women are diagnosed and treated for breast cancer that may not have posed a risk to them during their lifetime. This overtreatment can cause women unnecessary physical and emotional harm, the Australian research team explained.
The study included nearly 900 women, ages 48-50, who had not had mammography screening in the past two years and did not have a personal or strong family history of breast cancer.
Some of the women were assigned to a "decision support group," where they learned about the risks of over-detection and overdiagnosis associated with mammography screening.
Compared to women who didn't receive the information, those in the decision support group had less favorable opinions about the screening and were much less likely to undergo it.
"Mammography screening can reduce breast cancer deaths, but most women are unaware that inconsequential disease can also be detected by screening, leading to overdiagnosis and overtreatment," study lead author Kirsten McCaffery, of the University of Sydney in Australia, said in a university news release.
The study "underlines the ethical imperative for women to have clear decision support materials so that they can make more informed decisions about whether they want to have a breast screening mammogram," she added.
Dr. Alison Estabrook is chief of breast surgery at the Comprehensive Breast Center at Mount Sinai Roosevelt Hospital in New York City. She agreed that -- as happens with all cancer screening tools -- mammograms can lead to overdiagnosis.
She said the study brings up a number of important questions: "Can we find a group of women that does not need to be screened every year? Can we educate surgeons and other breast oncologists not to overtreat early cancers?"
But Bernik also believes that the Australian study had some flaws.
She noted that the women in the study hadn't gotten a mammogram for at least two years. "Women who chose not to get mammograms may feel more strongly about their decisions than women who go every year," Bernik noted.
"They may also be more eager to give their opinions than women who are committed to following a yearly routine," she added. "The study also excluded women who are at high risk, a group of women that are usually highly informed about whether or not they feel mammograms are beneficial."
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