Tuesday, November 17th, 2009The Mammogram Debate Leading the news this week was the recommendation by the United States Preventive Services Task Force (USPSTF) that routine mammogram screening for women of average risk be changed from age 40 to 50. Clearly this panel of "experts" have not been watching the steady flow of age forty something women come through the breast cancer program at my hospital. According to the USPSTF the number of woman in their 40's that are emotionally and physically "harmed" by undergoing biopsies for what turns out to be benign findings outweighs the actual cancers that are detected. Thousands of women in their forties are diagnosed with breast cancer each year and their lives are saved because of the availability of early detection and early treatment. The USPSTF agrees that screening mammography saves lives, but states "just not enough of them in the 40-49 age group". I am outraged by that statement. Why should any death that can be prevented not be enough?
Unfortunately some harm has already been done by the media informing women that they should not be screened until age 50. According to the CBS news the George Washington Hospital was flooded with women cancelling their routine mammograms today.
There is much anger over this issue in the medical community. I did not encounter any physicians today who are planning on telling their patients to delay screening. This morning the American Cancer Society and the Susan G. Komen for the Cure Foundation released statements rejecting the USPSTF's recommendations. Both organizations will advocate for screening to begin at 40. The battle lines are drawn and I hope women will rise up and let their voices be heard.
RickMonday just said everything that needed to be said about it...
One doc, a primary care physician, said that the stress and anxiety that some women go through while waiting on results of 'additional' testing is quite extreme. I guess the response to that is that 'a few weeks of anxiety, no matter how bad, is better than being dead.'
As for mammograms, they aren't exactly "harm free" as I have heard a number of people say. I mean, you are radiating your body. I, for instance, am 38 (in a few weeks). I have had discussions with my gyn about whether to have a baseline. I know some people that have a baseline mammo at 35. However, I don't have any family history, and my breasts aren't particularly dense (so it's easy to feel around --- maybe that's tmi...)... but we agreed that at this point, there is no strong push for subjecting myself to further radiation. At this point, I'm not sure which way I'll go in two years.
But, I think that my case kind of points to what I haven't heard discussed... family history and other factors that make a person more or less at risk. Seems like the guidelines could be for someone who is less at risk.
Also, my understanding is that the decision is based on two randomized studies (which are the best kind scientifically), one in China and one in Russia. So, although the type of study is the best in terms of scientific data, the populations are quite different from the US population. Given that, I have less confidence in the statements.
As for not doing self exams, I agree that there is no reason not to. However, in the study there was no difference in the group that did vs. the group that didn't. So... fine... no difference. But if there is no real reason not to, then why not?
What bothers me more now is that women are getting conflicting messages. And.... I can't help but mention the fact that the medical world is so "male centered" and wonder whether if there were similar results for say, prostate cancer, would they have made the same recommendations?
I don't mean to be defending the new recommendation, but I did find it worthwhile to hear other facets of the discussion.
The type of radiation that mammography uses is very low dose. Much lower than a chest xray or bone xray. Many studies have been done and I don't know of any that show mammography as a contributor to developing breast cancer. I do not disagree that having a biopsy can be a terrifying experience for some women and the waiting for results is often the worst part. What I find hard to accept is that we live in an age with such amazing technology, yet mammography still remains the best means of detecting breast cancer. Yes, mammography has improved with digital technology, but it still misses way too many cancers. All the recent reports talk about the false positives yet nobody is discussing the many cancers that are present but not detected. Tonight I went to hear a lecture on cancer clinical trials and I sat between 2 women (ages 41 and 43) recently diagnosed with breast cancer. The 43 year old told me that she had recently gone to see her gyn for her annual exam and was told that she had been advised for the past several years to get a mammogram and had never followed through. The gyn told her if she didn't go this year she couldn't come back to her practice the following year. She went 2 weeks later, it was abnormal, she had a biopsy and the result is stage II breast cancer. The woman said "That doctor saved my life". When I asked the woman why she was so reluctant to get a mammogram she said nobody in her family had ever had any kind of cancer. The truth is that 80% of breast cancers are found in women with absolutely no risk factors. Some of the healthiest women I know have been diagnosed with the disease. It's a personal decision whether to get screened or not. I hope you think about it carefully and don't let the media hype and the recommendations based on a study whose validity are now being questioned be a deciding factor. Talk it over with your doctor.
Since then, the pap smear recommendations have changed. And there is significantly less uproar about that, and I think for good reason.
After much thought and listening to many different people on both sides, I don't think the new mammo guidelines are a good move. It just takes me longer to process everything.
I had a baseline mammogram at age 35 and started mine yearly at age 40. In 2008, I had an abnormal scan, so I had to repeat in six months - everything was fine, then, but I was SO happy that I had a healthy baseline for comparison at Komen. That gives me peace of mind!