What's next for breast cancer screening?


The release last November of the U.S. Preventive Services Task Force's new guidelines on screening for breast cancer prompted an immediate firestorm. The Task Force departed from its previous recommendations, and those of several other groups, by no longer advocating routine screening mammography before age 50 in average-risk women and recommending against teaching women to perform regular breast self-exams. Some critics accused the Task Force of trying to ration care, and questioned the timing of the guidelines' release as politically motivated. Others, including ACP, defended the Task Force's work in conducting evidence-based research to guide clinical decision making. The furor even led to congressional hearings and an amendment to the Senate health reform bill requiring insurers to cover mammograms.

But now that the dust has settled a bit, what's next? Regardless of whether internists choose to follow the new guidelines, patients will come to the office with questions about them and will expect their physicians to have answers. In our cover story, Kathy Holliman reviews the controversy and offers experts' tips on how internists can approach this sensitive issue in their day-to-day practice.

The primary care shortage in the U.S. is no secret, and several medical schools have begun addressing the problem from the ground up. One program in Pennsylvania, for example, waives students' fourth year of medical school tuition if they make—and keep—a pledge to focus on primary care. Another program tries to show students the rewards of a primary care career by offering half-tuition scholarships and full-time clerkships in rural areas. Also starting on page 1, Stacey Butterfield looks at these and other innovative ways of encouraging medical students to embrace primary care as a long-term career choice.

As always, we want to hear from you. If you have an opinion about the breast cancer screening controversy, or an idea on attracting new blood to primary care, let us know. Also, comment on our blog or follow us on Twitter.