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Month: June 2015

New mammogram recommendations spark debate

Have you heard about the current debate over breast cancer screening?  It’s a heated topic. We are all at risk for breast cancer, even our male counterparts. Our risks increase with our age. Well, ladies, age is the current debate. What age is best to start breast cancer screening if you have no family history or risk factors?

Let’s look closely at this debate, which has come about because of new recommendations by the U.S. Preventive Services Task Force. This task force is recommending that a woman start her routine breast cancer screening NOT at age 40, but 10 years later — at age 50. To be clear, this is if you have no family history of breast cancer or risk factors like dense breasts, history of chest radiation or other medical concerns. The recommendation also states that mammogram screenings not be done annually but every two years, unless medically indicated otherwise.

You may be feeling a mix of emotions at this thought, especially if you have had breast cancer, know someone who has or if it’s in your family history.

You may be thinking, who are they and how are they suggesting this bold change? The USPSTF was created in 1984 as an independent panel of national medical experts who volunteer to review current health-care practices and then compare this to our evolving knowledge of evidence-based medicine. Based on this review, this panel then makes recommendations that aim to improve the health of all Americans through screening, counseling or primary care medical services offered. The U.S. Congress has authorized this panel to convene annually to present any needed recommendations to affect change to improve our health-care practices.

The panel believes that the practice of performing mammograms prior to age 50 in the general population does not warrant the risks to women of a younger age. Again, this means a woman without a family history or medical history placing her at risk for breast cancer. The most common harm of a mammogram prior to age 50 is a false or inaccurate reading, which results in additional unnecessary tests and procedures.

This is a major cost to our health-care system, as well. For instance, if a 40-year-old woman is told her mammogram shows possible tumors, she then goes on to have more imaging and, ultimately, a breast biopsy. If the biopsy shows normal breast tissue, the initial mammogram was therefore wrong. Could this biopsy have been avoided? Did this biopsy cause harm? Does this cause unnecessary anxiety or added discomfort to a woman? What are the overall costs to society? Bottom line, is it all worth it?  This is the argument.

I can tell you, there is a great divide in medical opinion about how and when breast cancer screening should be done in the United States. As an obstetrician gynecologist, our national organization, The American College of Obstetrician Gynecologists, has held firm that we believe it is best to start breast cancer screening at age 40 for ALL women. We also feel it is a personal decision and should be discussed with your health-care provider.

I feel strongly that the present debate might place our personal choices, access to screening and medical coverage in jeopardy over such divided opinions. It’s important that we remain a knowledgeable and active voice in this debate.

Let me show you some of the evidence for breast cancer that we know at present. Unless you have a family history of breast cancer, we all have a 1 in 8 risk of developing breast cancer in our lifetime. Think of you and seven of your girlfriends. One of you will develop breast cancer in your lifetime. If you have a family history, the chances are even higher. To make this even more real to you, let’s look at the evidence.

The lifetime risk of breast cancer by age is as follows:

  • In her 20s, one woman in 1,760 has a chance of breast cancer.
  • In her 30s, one woman in 220 has a chance of breast cancer.
  • In her 40s, one woman in 69 has a chance of breast cancer.
  • In her 50s, one woman in 42 has a chance of breast cancer.
  • In her 60s, one woman in 29 has a chance of breast cancer.

Do you see how time is of essence when it comes to this cancer? It’s important to discuss and consider this debate, not just from a personal perspective but to help educate and advocate for all women. Breast cancer screening is proven to play an important role in diagnosing breast cancer early, and therefore improving a woman’s chances for survival through early treatment and ultimately a cure. The pain of losing a loved one from a completely detectable and survivable cancer cannot be described.

You have the power to be a part of this ongoing debate and the time is now. One would think it is only logical to find breast cancer fast and find it early, right? Well, unfortunately with this and really any cancer screening, it is not so simple. It is a matter of evidence-based medicine, meaning we track hard evidence about current medical practices and patient outcomes. This information is then used to apply a recommendation or practice which is best for the entire population. It is not just a matter of medicine, sadly, but of access, effectiveness, cost and certainly insurance coverage.  The guidelines for insurance coverage follow recommendations created by our national organizations and governmental guidelines.

You may become involved by contacting your local government representative. The U.S. Preventive Services Task Force has invited you to voice your opinion by going to their website, www.screeningforbreastcancer.org