Mammogram screening guidelines and organizational differences in anticipatory guidance

Anticipatory Guidance Project

Mammogram screenings guidelines

The suitability of screening mammography has been a contentious issue because of a number of reasons. For instance, the lack of consistency of screening guidelines reveals the complexities in coming up with definitive conclusions on the suitability of the procedure. Another issue with mammographic screening is the degree to which a mammography helps to reduce mortality among women. There have been arguments from some quarters that there is no evidence that mammography reduces mortality. In addition, sometimes screening can provide false-positive results resulting in needless additional testing, which may include the probability of invasive surgical processes. These controversies have elicited intense debates from various components of the society.

Background information about the guidelines

The American Cancer Society gives a number of guidelines on mammogram screenings (The American Cancer Society, 2013). First, it recommends that women who are 40 years and older of age should undergo a mammogram every one year, and this should go on as long as the woman in question is in fine health. Second, women who are at a higher risk, that is, higher than 20% lifetime risk, should have a Magnetic Resonance Imaging (MRI) and a mammogram every year. On the other hand, the United States Preventive Services Task Force (USPSTF) gives a number of changes in the screening guidelines for breast cancer (Nundy, 2010). The USPSTF, recommendations include changing the routine screening of an average-risk woman to begin at 50 years of age, instead of 40 years of age. The task force also recommended that the routine screening should be stopped at the age of 74 years. Another recommendation by the USPSTF is that mammograms should be done after every two years instead of every one year.

Purpose of the paper

The function of the paper is to give an analysis of the opposing guidelines on the mammogram screening by the United States Preventive Services Task Force, and the American Cancer Society. Of the two protocols, the researcher will select one that seems to provide suitable mammographic screening guidelines. This will help to construct an anticipatory guidance for the mammogram screenings. The guidelines that this study will use are the ones discussed above, that is the American Cancer Society guidelines and the United States Preventive Services Task Force guidelines.

Research supporting the protocols

According to Brant and Helms (2012), observational researches have shown that women between the ages of 40 and 49 are more likely to have late-stage cancers diagnosed, if they are screened at the interval of two years as compared to an interval of one year. This forms the basis of the USPSTF recommending that routine screening should be after every two years instead of one year. However, other studies on the cancers that occur between two screens have indicated that breast cancer grows faster in young women than in older women. This informs the American Cancer Society's recommendation for annual mammographic screening for women at 40 years and older. Despite this, the chance of diagnosing the disease in women between 40 and 49 years of age is extremely slim at about 2% while that of death is about 0.3%. According to Nundy (2010), there is no sufficient evidence to indicate that screening beyond the age of 75 years is beneficial. This is the reason why USPSTF recommended that mammographic screening should stop at the age of 74 as women older than 74 years are likely to die from other causes other than breast cancer. However, the health of women older than 75 years varies from one woman to another. According to Nundy (2010), there is no evidence to indicate that screening reduces mortality rates for women beyond the age 74 years. Regular exposure to mammographic screenings may have an influence on the outcome of the screenings, in most cases leading to false positives (Nundy, 2010). This is the reason why USPSTF recommends that screenings should be less often.

Protocol chosen

The protocol that is more suitable is that of the American Cancer Society. One needs to consider the fact that all women are at a risk of developing cancer, and therefore, should consider including as many as possibly one can. In addition, women beyond the age of 70 years are at an elevated risk of being affected by breast cancer, and therefore putting an age limit of 74 years will expose these women to the risks of the condition (Nundy, 2010). Instead of limiting the screening to the age of 74, older women should make such decision after a discussion with their health care providers to determine the risks and benefits. The health care providers should provide adequate information about the risks that may arise from the screening for informed consent from the women. It is also essential to note that health status of women above 75 years differ from one woman to another, therefore having a generalized limit on women above 75 years is unnecessary. In making a decision of whether a woman of any age should undergo a mammogram screening, the health condition of the woman should be the key. A woman who has considerably few health problems should have the mammographic screening although a woman suffering from a terminal illness should discontinue as it will not be beneficial.

Investigations on the cancers that come about between screens show that breast cancer grows faster in young women than in older women (Brant and Helms, 2012). This means that the screening must be more regular in young women. The American cancer society's recommendation to have mammogram screenings start at the age of 40 years is more suitable than the USPSTF's recommendation of 50 years of age. In addition, the USPSTF does not recommend for additional screening of women at a high risk should happen. To reduce the risk of breast cancer among women who are at higher risk, an additional screening is essential, and women who think that they are at higher risk should discuss this with their medical providers determine whether this is necessary as recommended by the American Cancer Society (Nundy, 2010).

Medicare insurance covers people above 65 years only. This means those below 65 years cannot access screening services if they have no other healthcare insurance programs. However, Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) coverage programs allow one to start screening as early as possible. HMO links healthcare providers with insurance companies to provide health services to people at a fixed price. PPO also provides health care plans to individuals at a reduced price for preventive measures that include routine screenings. Under the plans, individuals pay a given amount of his or her healthcare expenses annually before the insurance plans start paying for them (American Cancer Society, 2013). Therefore, this supports the American cancer society's idea of starting screening at the age of 40 since one can now access screening services with ease.