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Mammogram Recommendation Major Turnabout

Posted by Jane Akre
Tuesday, November 17, 2009 10:46 AM EST
Category: Major Medical
Tags: Breast Cancer, Mammograms, U.S. Preventive Services Task Force, American Cancer Society, Mayo Clinic

Mammogram recommendation changes have the health care community divided.

Health Care Community Divided

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IMAGE SOURCE: Breast Cancer Action logo from Web site

It’s no wonder women are confused, as are doctors and health care providers. For years women have been told the importance of having an annual mammogram to screen for breast cancer.

Now, an influential group is saying that women in their 40s don’t need routine mammograms, according to a report published online Monday in the Annals of Internal Medicine.

For Joy Fashauer, 49, the overhaul in breast-screening recommendation doesn’t make sense. The Jacksonville, Florida woman is a staunch supporter of mammograms, even though one failed to detect a lump in her right breast two years ago.

“If you ask any woman who’s had breast cancer, she’ll tell you it’s well worth it,” says Fashauer who has been treated and is now cancer free.

The Recommendations

The U.S. Preventive Services Task Force released the recommendations. As the group that sets government policy on prevention, it questions the benefits over risk.

"There are important and serious negatives or harms that need to be considered carefully” says vice chairman of the group, Diana Petitti.

A survey of major studies reveals that mammograms produce false-positives in about 10 percent of cases. Upon hearing the news, doctors often recommend surgery, disfiguring biopsies, radiation, and chemotherapy, all that result in a lot of anxiety.

The recommendations now state that women should have mammograms every other year beginning at age 50, not annually or every other year at age 40, as previously recommended, and that women over the age of 74 do not need to continue regular mammograms.

Women with a family history of breast cancer should continue annual screenings.

What stands out as particularly odd is that the panel recommends women not do regular self-exams of their breasts. It also questions whether the more expensive yet clearer picture that comes from digital mammography is superior to images that use film.

Not Everyone is Onboard

The American Cancer Society and American College of Radiology are not onboard with the change. The groups believe that regular mammograms reduce the number of more advanced cancer cases that are detected therefore reduce the number of mastectomies and deaths.

“The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40” said chief medical officer Dr. Otis Brawley in a statement.

He admits that there are more false positives at the younger age and “overall effectiveness of mammography increases with increasing age.”

“The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group. Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. The American Cancer Society feels that in both cases, the lifesaving benefits of screening outweigh any potential harms. Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early” continues the statement.

The new recommendation echo the same change promoted in 2007 by the nation’s internists. Dr. Douglas Owens, a health policy expert and researcher with the Veterans Affairs Palo Alto Health Care System and Stanford University, who led the recommendation back then, told the San Jose Mercury News that he applauds the new guidelines.

“There is growing recognition of some modest but potential harm that needs to be weighed with modest benefits of using mammograms in younger women,” he tells the paper.

The Mayo Clinic’s Jacksonville campus expressed concerns about the message. Michelle McDonough, a radiologist tells the Times-Union,”We’ve made great strides in this reduction in breast cancer mortality. And we’re afraid that if we prematurely tell those patients not to use those screenings, we could see some of those gains eroded away.”

A patient advocacy group, Breast Cancer Action applauds the decision.

Deputy Director Joyce Bichler says, “The benefit of mammography has been totally oversold. What the task force is recommending may confuse women, but we hope they’ll be able to look at the evidence and discuss it with their doctor, to make the right decision.”

The group points to not only false positive results but the cumulative exposure to radiation that occurs from mammograms over the years. #


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