News released at the end of November rocked the world of breast-cancer health-a government task force has recommended a more conservative approach to mammograms.
Many are questioning the change. “I think it is unfortunate that they came to this conclusion,” said Dr. Angela Sie, director of imaging at the Breast Cancer at Long Beach Memorial Hospital. “It would be a huge step backwards for women’s health in this country.”
The new guidelines basically say that most women age 40-49 are at higher risk for false positives and complications from biopsies and other invasive procedures, and therefore shouldn’t undergo routine mammograms until they turn 50. In the past, women were told to have annual mammograms after turning 40 years old.
The American Cancer Society doesn’t agree, and is going to continue to recommend annual screenings for women older than 40. Many radiologists have similar feelings. “The net effect of the new guidelines is that screening would begin too late and its effects would be too little,” says Stephen Feig, MD, professor of radiology at the University of California at Irvine and president-elect of the American Society of Breast Imaging. “We would save money, but lose lives.”
The task force insists that cost had nothing to do with their recommendations, and in fact, that they are prohibited from considering cost when they make guidelines. “Cost just isn’t a consideration when the task force deliberates,” said Ned Calonge, who chairs the 16-member panel of experts appointed by the federal Department of Health and Human Services. The panel includes scientists and professors specializing in prevention and primary care.
Many organizations welcome the new guidelines, such as the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network. “This is our opportunity to look beyond emotions,” said Fran Visco, president of the National Breast Cancer Coalition. “These are the people we should be listening to when it comes to public health messages.”
In fact, the debate over mammograms has been ongoing for several years. In 1997, a federal committee of medical experts recommended against routine mammograms for women in their 40s. Why the hesitation? Bottom line: mammograms can do harm as well as good, particularly for younger women. Many routine mammograms result in false alarms for younger women with denser breasts; create extra cost and anxiety with unneeded biopsies and tests; increase radiation risk (the earlier you begin mammography, the more radiation exposure you will experience); and may put women through unnecessary surgeries and chemotherapy for slow-growing cancers that would have never sickened them-all without substantially improving women’s odds of survival.
“Regular screening will save some lives,” says Lisa Schwartz, MD, associate professor at Darmouth Medical School, “but it will cause even more women to be harmed through the unnecessary diagnosis and treatment of cancer that would have never affected their health, were it not for screening.”
The risk that a 40-year-old women will die of breast cancer in the next 10 years is small-just 0.19%, according to data from the National Cancer Institute (who is currently considering the new recommendations). The risk that she will be diagnosed with invasive breast cancer before turning 50 is 1.44%. Yet the risk of false positives is 60% higher in women in their 40s than those in their 50s. Younger breasts are denser and harder to evaluate.
According to a 2006 Cochrane Review, “For every 2,000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings.” According to the National Breast Cancer Coalition, U.S. estimates show a woman’s cumulative risk for a false-positive result after 10 mammograms is almost 50 percent.
What some may be forgetting, in the midst of all this debate, is that a mammography is just a tool to try to detect cancer-it’s not a preventive mechanism, and it doesn’t reduce risk. For that, women need to turn to diet, exercise, and stress-reduction. In the meantime, for those women between the ages of 40-50 who are questioning their screening future, the new recommendations underscore one certainty-women are different, and science isn’t perfect. Each woman needs to evaluate her own risk factors-family history, current health, cigarette and alcohol use-and make a decision together with her doctor that best serves her interests.
What do you think of the new guidelines? Please share your thoughts.
Photo courtesy ms. Tea via Flickr.com.
