Breast cancer is the second leading cause of cancer deaths in the country. It is an accepted premise that early detection helps in the treatment of cancer and can prolong lives. The one diagnostic tool to detect any abnormality in breast tissue is mammography.

But the American College of Physicians contends the procedure is not without risks in women who have a low tendency to develop breast cancer. In its new recommendations, the group said routine mammography screening in low-risk population was unwarranted and caused more harm than good.

The ACP recommendations are published in the April 3 issue of the Annals of Internal Medicine.

The guidelines are contradictory to those issued by the National Comprehensive Cancer Network, American Cancer Society, United States Preventive Services Task Force, and American College of Obstetricians and Gynecologists. Breast cancer detection is vital at its earliest stage and hence women over 40 need to get annual or biennial mammograms even if their risk is normal.

The ACP disagrees with these guidelines and says:
* Doctors should perform individualized assessment for breast cancer risk in women ages 40 to 49. These regular assessments must ultimately determine the necessity of mammography screening.
* Further in this age group mammography decisions must be based on benefits and harms of screening and women must be fully informed about both these conditions.
* The breast cancer-risk profile of a woman must be assessed before deciding on mammography.
* For women 40 to 49 years of age, the benefits and harms of breast cancer screening must be researched thoroughly.

These ACP guidelines can only be bypassed in conditions where the breast cancer-risk profile is positive. Such situations include presence of BRCA1 or BRCA2 susceptibility mutations, any chest irradiation or when the woman has had previous diagnosis of breast cancer, ductal carcinoma in situ, or atypical hyperplasia.

“We agree that mammography can save lives,” said Douglas K. Owens of Stanford University, chair of the committee that wrote the guidelines. "But there are also potential harms. We don't think the evidence supports a blanket recommendation.”

Last week's American Cancer Society recommendations called for an annual MRI exam in women at greatest risk of breast cancer. Obviously these new ACP guidelines have baffled many, Robert A. Smith; director of cancer screening at the American Cancer Society said most women could elect not to get screened.

“Mammography is the single most effective way of finding breast cancer early, and when we find breast cancer early, women have the greatest chance of successful treatment," he added.

In fact an editorial in the same journal suggests decision making on mammography is not easy. Joann G. Elmore, M.D., M.P.H., and John H. Choe, M.D., M.P.H., of the University of Washington write that no single recommendation applies to all women in their 40s.

"We must learn to become comfortable with using the art of medicine to translate the existing science. We must listen carefully to our patients and communicate honestly the benefits and limitations of our imperfect tests," they added.

The American Cancer Society estimates that in 2007 about "178,480 new cases of invasive breast cancer will be diagnosed among women in the United States." It adds that this year "40,460 women and 450 men will die from breast cancer in the United States."

Mammography remains the best weapon to catch cancer at an early stage. Women over 40 years must take all factors into consideration before arriving at any conclusion regarding their own breast cancer risk and undergoing mammography.