The U.S. Preventive Services Task Force (USPSTF), part of the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, has just released new guidelines that have stunned the industry as these guidelines are significantly different from the standards that have been recommended by groups such as the American Cancer Society.

First, the USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The agency says any decision to commence regular, biennial screening mammography before the age of 50 years should be an individual decision and take patient context into account, "including the patient's values regarding specific benefits and harms." The USPSTF gives a "C" grade to this recommendation, meaning there is at least moderate certainty that the net benefit is small.

Next, the USPSTF recommends biennial screening mammography for women aged 50 to 74 years. This has a "B" grade for recommended service, meaning there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

Next, the USPSTF reports it has concluded that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. This recommendation has the grade of an "I Statement". An I Statement means that the USPSTF has concluded that the current evidence is insufficient to assess the balance of benefits and harms of the service. The evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

The USPSTF has also recommended against teaching breast self-examination (BSE). This recommendation has a grade "D." For grade D, the USPSTF recommendation against the service is because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. In its Clinical Summary, the USPSTF says "Adequate evidence suggests that BSE does not reduce breast cancer mortality," and has harms including "false-positive results, which lead to anxiety, unnecessary visits, imaging, and biopsies."

Further, the USPSTF has concluded that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. This recommendation also has an I Statement. In the Clinical Summary, the USPSTF says this procedure has the same harms as BSE.

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