By Ken de la Bastide
For most of their lives, women have been urged to get annual mammograms and do self-examinations to detect breast cancer as early as possible.
Monday, the U.S. Preventive Services Task Force said there is no evidence breast self-exams lead to fewer deaths and recommends women over the age of 50 get a mammogram every two years.
It is a recommendation the American Cancer Society is not agreeing with, nor is it one being shared by some local physicians.
“The American Cancer Society acknowledges the limitations of mammography, and we remain committed to finding better tests,” Dr. Otis W. Brawley, chief medical officer of the cancer group, said in a prepared statement. “In fact, data show the technology used today is better than that used in the studies in this review. ... As scientists work to make mammography even more effective, the American Cancer Society’s medical staff and volunteer experts overwhelmingly believe the benefits of screening women aged 40 to 49 outweigh its limitations.”
The American College of Radiology in a statement on its Web site was critical of the federal panel’s recommendations.
“Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent,” the ACR stated.
A 32-year-old Kokomo resident being treated for breast cancer said she doesn’t agree with the recommendation from the federal panel. She asked not to be named.
“If I had to wait until I was 50, I’d be dead,” she said.
The local resident said she is in the high risk category because her mother was also diagnosed with breast cancer. Given that history, she would still be eligible for a mammogram.
Dr. Sarah Longmire-Cook, a breast surgeon at St. Joseph Hospital, called the new recommendation premature.
“The U.S. Preventive Services Task Force study looked at six different statistical models that predict outcomes regarding screening tests,” Longmire-Cook said in a statement. “Those six models suggested that if we delay regular mammograms until age 50, we still get 80 percent of the benefit, in other words most of the benefit of regular screening is in the 50+ age group. But that means we lose 20 percent of the benefit. And the 20 percent who are under the age of 50 and who would go undiagnosed are the younger women who may have small children … they are someone’s mom or daughter or sister or best friend.
“The number of patients who are diagnosed through regular mammograms may be smaller in the 40- to 50-year-old age range, but the number of life years saved is significantly higher,” she said. “What the task force called ‘unnecessary biopsies,’ we call good news.”
Longmire-Cook said since the study was based on statistical models, rather than clinical research, it is premature.
“In my practice, I see a significant number of breast cancer diagnoses in patients in their 40s,” she continued. “If insurance companies stop covering mammograms for those women, we lose the benefits we’ve achieved from early detection.”
Dr. Sandeep Ahluwalia, with Summit Radiology affiliated with Howard Regional Health System, said the hospital is not changing its recommendations for women to start having annual mammograms at age 40 and do self-examinations.
“The new recommendations are not well founded,” he said. “We’re standing by the recommendations by the American Cancer Society and the American College of Radiology, which is based on multiple studies.”
Ahluwalia said the U.S. Preventive Services Task Force based its findings on statistics and ignored many studies.
“Lives are important,” he said. “Early detection is the key. A screening mammogram costs less than $100.”
Ahluwalia said nothing surprises him anymore when it comes to recommendations coming from Washington, D.C.
He said a concern is that some women will stop getting mammograms and conduct self-exams as a result of the new recommendation.
“Whenever there is conflicting information, people who don’t want to go to a doctor anyway, now won’t,” Ahluwalia commented. “The two biggest organizations are not changing their recommendations, which is founded in scientific research.”
• Ken de la Bastide is the Kokomo Tribune enterprise editor. He can be reached at 765-454-8580 or via e-mail at ken.delabastide@ kokomotribune.com
