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New mammography guidelines continue to spark debate

BY SUSAN MCCLURE | DECEMBER 12, 2009

You'll recall the public outcry that occurred in October when the U.S. Preventive Services Task Force issued a report that recommended significant changes to existing mammography guidelines. The debate continues among physicians, scientists, and advocates here in San Antonio.

Back in October, the 16-member committee recommended that most women in their 40s should not routinely get mammograms. Additionally, women 50 to 74 should get mammograms every other year until they turn 75, after which the risks and benefits are unknown. Women 75 and older should not get regular screening. The committee is also against teaching women to do regular self exams because "the value of breast exams by doctors is unknown and breast self exams are of no value."

The American Association for Cancer Research (AACR) released a response to the new guidelines which stated that they recognize that these are complex issues that encompass a broad range of areas - medical, scientific, public health, economic and sociological - and that the interpretation of these data can result in legitimate disagreement among respected leaders in their fields. Decisions on the delivery of screening methods and treatment of cancer should be evidence based and that the "state of the art" in the field is evolving and will continue to change as our understanding of the biology and genetics of cancer is better understood. They also recognized that mortality rates from breast cancer have been falling since the mid-1990, and they believe that this is attributable at least in part to the more widespread utilization of mammography screening and other factors. Their statement concluded by saying that the issues are simply too complex to make a clear statement at this time supporting either the existing guidelines or those proposed by the USPTF.

To me, that response equates to issuing a "no comment."

The Breast Cancer Network of Strength took a much more definitive stance. Margaret Kirk, the foundation's President and CEO said, "We know that earlier diagnosis and treatment of breast cancer leads to better outcomes. As an organization that hears from tens of thousands of women through our 24/7 YourShoes support center, we would be disappointed if this new recommendation became yet another barrier that women will have to overcome to get the care they need."

Over 7,000 people have sounded off about the new mammogram guidelines by signing Breast Cancer Network of Strength's petition. You can too by clicking here.

I was 35 when I found my lump and had it confirmed via mammography and biopsy. It's important to note that my mammogram was considered diagnostic and would still be covered under the new recommendations. However, had I done the mammogram two months earlier, when my doctor recommended it at my annual check up, it wouldn't have been because the tumor hadn't been detected then. At 35, and with no family history, I felt invinsible. I procrastinated.

I salute Margaret Kirk and the Breast Cancer Network of Strength for keeping the public's voice at the forefront of this issue.

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COMMENTS

While women's voices matter, some of us feel that the evidence is also important. What the evidence tells us is that you have to screen nearly 2,000 women for 10 to 20 years to save a single life. Why would anyone petition to support a test that does such a terrible job at saving women's lives? Breast cancers are not alike. Some are slow-growing and will never become life-threatening, while others manage to spread long before they can be seen on a mammogram. Mammograms are pretty good at finding the kind of slow growing cancers that turn out not to be life-threatening--find them now, or find them later, you'll still survive. That's why the incidence of these slow-growing early cancers grows and grows, but with no corresponding decrease in locally advanced and metastatic breast cancers.

What we urgently need is not more mammograms, but funding for research to find testing that will truly detect the disease before it has had a chance to spread and threaten our lives. American women are angry--yes, but they ought to be angry at those who have sold us a bill of goods...We need a better test!

Musa Mayer
www.AdvancedBC.org
- Posted by Musa Mayer 12/12/09 12:05 PM

I agree- shouldn't we have a better screening tool for breast by now other than a mammogram?! We've been using mammograms for over thirty years I think and like you said, often they are not effective at finding fast-growing, soon-no-metastasize cancers such as my mother's. At age 43 she felt a lump in her breast (that the mammogram did not show because her breasts were so dense) and only two months later found a distant metastasis in her spine; it had probably spread to the spine much before she even felt the lump. After a long 8-year battle she just passed away from the disease this year. Both of my grandmothers have also had breast cancer and as a woman with the family history and in her late twenties, I am confused and upset that there is nothing I can do to try and catch a possible breast cancer in myself. Doctors refuse to order a mammogram for me anyway because when you are young, your tissue is more dense and most women do not get breast cancer that young. But for those few women who do get it at a young age, like my mother, and like a college friend of mine who just died of breast cancer at age 29, we need something better! We need something similar to the PSA (prostate antigen test), a blood test that is not invasive, or what Dr. Susan Love has talked about in her breast book, needle biopsy of ductal tissue/fluid through the nipple. She said it is not that invasive and doctors can be trained; I don't think this procedure would work in all cases either, but why is there not more research and progress on this front? I have also seen ads for breast thermography (infrared imaging) that purports to be able to detect small changes in breast tissue and can be used on younger women. I have not tried it yet nor do I know the credibility or scientific suppport of this screening, but since I feel helpless based on my experience so far and especially because of the recent opinions on mammograms, I think I will give it a try.
- Posted by troisjs 12/12/09 5:03 PM

It isn't just screenings through mammography that the USPSTF recommended; the committee also recommended that self breast exams not be taught to young women. I performed my first breast exam at age 30 after a panel of breast cancer survivors spoke about breast exams and annual mammograms at a local networking luncheon. The results of that first self-exam led me to contact my doctor and ultimately to a diagnosis of breast cancer. I am currently Stage IV, with metastasis to the liver and bone, and can honestly say that if I had not been taught 14 years ago to do a self-exam, I would not be here today to argue the point.

I do agree with Musa's point that we need to funnel more dollars into research for better, earlier detection; however, I also think that while that research is being done, mammograms and breast exams are the best tools we have for detection; while we may not need "more mammograms," as Musa says, we absolutely do not need fewer!
- Posted by Kris Sulzberger 12/12/09 8:52 PM

This argument really fuels a lot of emotions and it's understandable. I have a different issue, which is one of health literacy. It has taken years to get women to be aware of mammography and the need to watch their breasts. And all women over 40 still aren't getting mammography. Now what women will hear is "don't get a mammogram, they do't work," instead of the whole story.
So fewer women will get mammograms and more will die.

Because I was only 37 at diagnosis, I had not had a screening mammogram when I was diagnosed. My diagnositic mammogram showed with 95% clarity that I had breast cancer.

What I do disagree with is that we stop teaching young women breast self exam, becasue this encourages women to take control of their bodies and their own health. There is no down side to this.
- Posted by Kathy LaTour 12/13/09 8:43 AM

For troisjs...there is another test other than mammography for someone with strong family history and it is MRI. You certainly qualify for this given your history and it does have a very high rate of detection of breast cancer. You don't have to look very far on the internet to get this information. So educate yourself and have your doctor order an MRI. Do not waste time on thermography!
- Posted by laine philpotts 12/17/09 4:07 PM

For troisjs...there is another test other than mammography for someone with strong family history and it is MRI. You certainly qualify for this given your history and it does have a very high rate of detection of breast cancer. You don't have to look very far on the internet to get this information. So educate yourself and have your doctor order an MRI. Do not waste time on thermography!
- Posted by liane philpotts 12/17/09 4:08 PM

If we were 20 years back, I would agree with less screening. But what most patients don't realize is that the screenings are changing. Women go for annaul mammograms and the process is the same, but the equipement is not. Films have continually become better pictures, year by year and with the new digital machines, the pictures are better than they have ever been. I work in an office where we perform mammograms and I can't tell you have much I hate having to call a patient to schedule further testing because they haven't had any problems and we found cancer.
We need yearly mammograms, in my opinion. I may be only 27, but with breast cancer in my family, I shudder to think that by the time I'm 35 I may not be able to have my baseline mammogram.
- Posted by Sharon 1/1/10 7:27 PM

If it was not for my self exam there is no telling how far my cancer would have spread before it was found. My tumor did not show on my mammogram and only because I kept complaining about a lump I felt was a sonogram done, which showed the tumor. A lumpectomy, chemo, radiation, and mastectomy later I am here to save women must advocate for themselves and know there own bodies.

Continue self exams and keep insisting if you know something is wrong. The life you save may be your own.
- Posted by Jo Ann 1/17/10 9:16 PM

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