The guidelines by the Canadian Task Force on Preventive Health Care (CTF-PHC) entitled “Recommendations on screening for breast cancer in average-risk women aged 40–74 years”1 negated mammographic screening in women aged 40–49 years, provided weak recommendations for those aged 50–74 years and discouraged routine clinical and self–breast examinations. How will breast cancer be diagnosed in the future?
Many women aged 40–49 will not opt for screening, and the expectation that most women between 50–74 years will may not bear out given only a “weak recommendation” is denoted. Without routine clinical breast examinations, physicians may not have records for future comparison. Without routine self-examinations, patients have no baseline on which any early changes may raise concern. Only one or more of the following obvious changes might raise concern: new nipple retraction, unrelenting unilateral eczema of the nipple areola complex, reddening and swelling of the breast, rapid enlargement of the breast, visible bulge from the breast, orange peel appearance and/or retraction of breast skin, ulceration of skin overlying a breast lump, or miscellaneous symptoms suggestive of regional or systemic metastasis. This is a regressive way of diagnosing breast cancer.
In the task force’s attempt to provide an evidence-based approach to mammographic screening, clinical common sense and consequences seem to have been overlooked.
The implication on women’s health is too great to be left without soliciting official position statements from the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada. Clinicians working in the field as well as the general public deserve clarification. Ultimately, the quality of breast cancer prevention, early detection and treatment may be compromised.