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Breast cancer screening: My practices and response to the USPSTF guidelines

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In a debate with George Sawaya, MD, at the annual scientific meeting of the American College of Obstetricians and Gynecologists regarding the breast cancer screening guidelines issued in 2016 by the US Preventive Services Task Force, Dr. Mark Pearlman, argued that the C recommendation for screening mammography in the age group of 40 to 49 years leaves out an important group—younger women who develop aggressive breast cancers. He also disagreed with the Task Force’s recommendation for biannual vs annual screening. In this interview with OBG Management, Dr. Pearlman expands on his reasoning and explains his own practice decisions.


 

Q. You argued in the debate that screening for breast cancer should start earlier than proposed in the USPSTF guidelines, as aggressive cancers are more likely to be found in younger women. The USPSTF recommends screening begin at age 50. At what age do you advocate breast cancer screening to begin?

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Q. One argument against beginning screening earlier is “overdiagnosis.” How do you respond to overdiagnosis as a concern?

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Q. How would you diagnosis breast cancer “just right” given the limited screening techniques (and limited understanding of DCIS)?

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Q. You mentioned that you do not like the language of benefits and harms and do not use them in your practice. What alternative language do you use when counseling patients?

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Q. What are your concerns with the USPSTF C recommendation for screening mammography among women aged 40-49?

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