On November 16, the United States Preventive Services Task Force caused a media tempest when it announced its most recent evaluation of the data regarding mammography screening. They reviewed all the data and recommended that we stop screening women under 50 since the data do not support a benefit that outweighs the risks. Women ages 50-74 should be screened every other year and that we don't have enough information on women 74 or older. While this is a shift in guidelines, it was long overdue, and now brings us into line with most other countries, many of which have government funded mammography screening programs.
Before addressing the change, it is important to review how it came about that the standard of care in the US is to screen women starting at 40. In fact, in January, 1997, there was a large consensus conference sponsored by the National Cancer Institute to discuss this issue. Independent experts representing researchers, clinicians, statisticians, epidemiologists, and consumers testified and 12 independent experts reviewed the data. Their conclusion was "...that the data currently available do not warrant a universal recommendation for mammography for all women in their forties." They recommended that women decide with their doctors on the best approach to take.
You would have thought that this reasoned approach would settle the issue but immediately a storm of acrimonious protest broke out as well documented by Virginia Ernster in the American Journal of Public Health. Within days of the conference and heavy lobbying by various special interest groups, the Senate voted 98 to 0 to endorse a nonbinding resolution that the presidentially appointed National Cancer Advisory Board recommend mammography screening for women under 50. By March a press conference was held to announce the NCAB's recommendation that the NCI advises women age 40-49 to have screening mammograms. So, the current recommendations, far from being scientifically based, were based on lobbying by interested parties seeking to support a public view which exceeded the science.
This brings us to the current task force which again went through a thorough review of the data supporting screening young women. They found that although there is a reduction in mortality by 15% in this group, it does not appear until the women are followed 11-20 years, in other words until they are over 50. The risks of getting mammography early in life include extra radiation. One estimate of the cumulative radiation risk for women 40-50 is that as many deaths could be caused versus prevented with yearly screening. Other risks include false positives or finding abnormalities that require investigation and even biopsy but do not turn out to be cancer. Finally, there is the over treatment risk from finding lesions that may look like precancerous lesions but in fact would never develop into cancer.
Are these new guidelines an example of rationing? You bet. They are an example of exactly how we need to ration health care, based on science. It is exactly this approach, health care standards by popularity rather than science that raise the cost of medical care in this country. The lack of a "comparative effectiveness" body to come up with recommendations and then enforce them, means that it is the third party payers willingness to pay for procedures that determines the standard of care. The absence of a government run screening program means that the uninsured cannot get screened at any age unless they are poor enough to qualify for a CDC program. The best way to improve the health care of all women and to prevent deaths from breast cancer is not supporting screening that is not effective but rather a health care reform that covers all with evidence based medicine.
Follow Susan M. Love on Twitter: www.twitter.com/DrSusanLove
According to the U.S. Census Bureau, there were 22,328,592 American women between the ages of 40 and 49 in 2009. One in 69 women in this age group will be diagnosed for breast cancer. That’s 111,643 American women who will be diagnosed with breast cancer before the age of 50. The report states that mammograms avert 3 deaths in every 1,000 women screened. That means that up to 66,986 women under the age of 50 who would have died, will not die if they get mammograms. The report then makesa giant leap to recommend against getting mammograms, failing to consider the difference in outcomes from early versus later screening. Quality of life following cancer treatment is affected by the stage of the cancer and the degree of treatment required (lumpectomy vs. mastectomy, lymph node dissection which can cause life-long discomfort and disfigurement).
The bottom line as far as I’m concerned is not that the Task Force is indelicate in communicating their conclusions nor that angry people have overreacted, but that the recommendations fly in the face of the conclusions and the research cited in the report.
Had I followed the advice of the radiologist who reviewed my mammogram, I would have been subjected to 10 or more biopsies to check out microcalcifications. Microcalcifications can indicate DCIS - encapsulated ductile carcinoma "in situ". There are risks that biopsies will spill cancerous cells that would otherwise remain encapsulated.
In the future, I will opt for thermography plus blood tests. Thermography deserves to be studied and developed more fully. As a stand alone diagnostic tool, or adjunct testing, it shows great promise.
Digital infrared thermal imaging (D.I.T.I.) is a totally non-invasive clinical imaging procedure for detecting and monitoring a number of diseases and physical injuries, by showing the thermal abnormalities present in the body.
Thermography Has been approved by the FDA for over 25 years! Read more at
http://www.thermologyonline.org/patients_overview.htm
What is Breast Thermography
http://www.thermologyonline.org/Breast/breast_thermography_what.htm
Breast Brochure - Breast Imaging
http://www.medithermclinic.com/Assets/Breast.pdf
I am not against mammograms, as I would just like to offer this as an adjunctive approach, a baseline for young women and or an alternative for women
* No Radiation - FDA approved
* Detects Cancer Sooner
* Cost Effective (average $150 a test)
* Non Invasive
* Portable/Mobile Clinics Offerered
Is It True that Breast Cancer Takes Years to Develop? When DOES a mammogram Detect Cancer? Year number EIGHT!!!! http://www.cvdinc.org/MediThermcell_doubling_rates.pdf
See More information on Men and Breast Cancer, research and News releases here!
http://www.cvdinc.org/Practicioner_Info.html
Also Excellent Pre and Post Surgical Monitoring. Many practicioners utilize this technology to track treatment of cancer therapy. They can Actually Visualize the Problem areas. http://www.cvdinc.org/files/MediThermthermalimagingbrochureinsidefinal_.pdf
Scan Centers in the US and WorldWide (NO DOCTOR REFERRAL NEEDED)
http://www.thermologyonline.org/Breast/breast_thermography_clinics.htm
Good Luck and Hope this helps for alternatives!
Carla J
Here are some unofficial numbers from a poll taken in one of my breast cancer support groups:
Question = At what age were you diagnosed?
Responders = 47 women
Diagnosed in 20s = 2
Diagnosed in 30s = 2
Diagnosed in 40s = 24 (11 age 40 – 45, 13 age 46 – 49)
Diagnosed in 50s = 13
Diagnosed in 60s = 6
I find it interesting that the very age group these new guidelines are saying does not need mammograms numbers the highest in this little poll. I know it is not scientific, but still…
If mammogram radiation is so bad, why not find a way to detect this disease with accuracy and without radiation? Since diagnosis, I have had numerous mammograms, five CTs, several chest X-Rays, back and pelvis X-rays, one foot X-ray, and 5.5 weeks of radiation therapy…Yet none of my doctors seem concerned about what all this radiation might do to me, or my prognosis. So why are these mammograms so dangerous?
Every woman is different. She should be able to decide, with her own doctor, what is best for her. Insurance companies WILL seize this as an excuse to deny mammograms. That should not be allowed.
Dr. Love deserves a hearing, she has been in the trenches for us for many years.
Could you please advise on an alternate to the mammogram for women under age fifty?
I understand that you are reading and selectively replying to this thread. If I do not get a response from you, I will assume that there is no such alternate test for women under fifty that you would recommend.
Please note, I was dx at age 35 -Stage 2a grade 3 - I was lucky. Regards.
"Ductal lavage is a diagnostic procedure being developed by breast surgeon Susan Love, MD and researchers at the company, Pro-Duct Health, to be used in addition to clinical breast exams and mammography.
Ductal lavage helps identify cancerous and pre-cancerous cells by examining samples of cells from the milk ducts of the breast. Dubbed the "breast pap smear," Dr. Love believes ductal lavage can help physicians better understand how breast cancer develops and identify women most likely to develop breast cancer."
Oh well, I guess the men can just go screw themselves, they won't have women to kick around any more.
This study was based on OLD techniques and INCOMPLETE info.
http://www.breastcancer.org/opinion/mammography_guidelines.jsp
So much for THAT science.
Lumpectomy and 7 weeks of radiation with Dr. Marisa Weiss. She rocks it, you can SUCK it.
I say we burn our copies of the Breast Book.
http://grassrootshealth.net/
By the way, i am a guy who gives myself self-exams when I think of it and I have talked to my sons about this also. Doctors should be telling males to do self-exams (and testicular exams for young men). I worked with a guy who found a lump when he was in his forties. Lucky for him his wife knew what it meant and he is still alive.
Usually, finding out involves additional and repeated mammograms, surgery, and a biopsy - all incredibly invasive, stressful and expensive for something that turns out to be nothing.
For any woman who has gone through the anxiety of a suspicious, but indeterminate mammogram, these new guidelines make sense.
The incidence of BC risk is increased for women with a history of benign biopsies.
Olive 1 out of 68 women in their 40s is diagnosed with BC.
I was diagnosed last year at 39 with a super-aggressive triple-negative breast cancer (TNBC). No family history, no known risk factors. Never had a mammogram since I wasn't "old enough", but with a 5-cm tumor and a Ki-67 of 100% I wonder how long I would have lived trying to wait 11 more years! We need screening earlier, not later!!
FACT: 19,000 to 38,000 women are diagnosed with TNBC every year.[1]
FACT: TNBC occurs most often in younger women and African-American women [2], commonly premenopausal (under 51) [3].
FACT: TNBC recurs in 32% of patients within 5 years, and average survival time after recurrence is 9 months [1].
By my calculations that works out to be 6,080 to 12,160 women in the US every year who DIE within 9 months from TNBC recurrence! And that's only TNBC!
FACT: I am one of the 19,000-38,000 women diagnosed with TNBC last year. My 5, 8, and 14 year-old children, husband, family, and friends are hoping I'm not one of the 6-12 THOUSAND who will die of it.
Wow.
Sources:
[1] http://www.curetoday.com/index.cfm/fuseaction/article.showArticleByTumorType/id/805/tumorCategory/Breast/article_id/1235
[2] http://ww5.komen.org/KomenNewsArticle.aspx?id=7482&terms=triple+negative+ag
[3] http://www.nia.nih.gov/healthinformation/publications/menopause.htm
People need to learn to set priorities. Insurance companies do NOT come first.