WHY WE NEED CONSENSUS ON MAMMOGRAM GUIDELINES

The debate about mammography heated up again last week after the American Cancer Society (ACS) changed its recommendations

to state that women did not need to begin receiving mammograms until after the age of 45 and that they can be done every other year starting at age 55.

The ACS is also no longer recommending that women have yearly clinical breast exams.

If you’re confused, let’s review the current recommendations. The American College of Obstetrics and Gynecology says mammograms should begin at age 40. The ACS says age 45. The United States Preventive Services Task Force says screening every other year beginning at age 50. Who are we to believe?

I have concerns with this recent change just as I had concerns when the USPTF issued their 2009 recommendations.

First, younger women (under the age of 50) are being diagnosed with breast cancer more than ever. About 20% of new diagnoses are in this age group and they tend to have the types of tumors that are more aggressive. How many of them would be missed by if they didn’t start getting mammograms until age 45 or 50?

Second, insurance companies use guidelines to make payment decisions. Will this change impact a woman’s ability to get a mammogram if she wants it but is unable to afford it? Legislation has been introduced in Congress to prevent this from happening; however it has not yet been passed.

I understand the issues related to false positive results, unnecessary biopsies and the anxiety that comes with that. No one wants a needle stuck in a breast if it’s not needed, nor do they want to sit around waiting and worrying for biopsy results that turn out to be negative (although that would be super-good-news to me).

I understand “overdiagnosis”. This leads to treatment of cancers that ultimately would not be life-threatening. Some physicians advocate a “watch and wait” approach for these tumors, although I would be hard-pressed to watch and wait for anything with a tumor in my body. I’m not that brave.

I understand the attempts to reign in health care costs. I work in that system which is so fabulously broken and see waste all the time.

I strongly support a woman’s right to choose when to start screening based on her history and comfort level. Granted, I am biased. My family experience with breast cancer has been nothing short of horrible. My mother died from it. My sister had it at age 40. My grandmother had it and endured long courses of cobalt treatment (twice).

Perhaps the advent of newer screening technologies will help. Breast MRI and 3-D images were shown in studies to be more effective for women with dense breasts, those younger than 50, and for pre- and peri-menopausal women. Thermography has also been studied, but the data is insufficient to recommend it as a reliable screening tool.

More than anything, I wonder why all of these groups can’t get in a room and come up with ONE set of recommendations. It would save us all a lot of worry and confusion. Until that happens, women are stuck with multiple sets of guidelines that really don’t provide a clear direction…and we deserve better. Talk to your healthcare provider about your risk factors and decide together what’s right for you.

http://www.drannagarrett.com/2015/10/why-we-need-consensus-on-mammogram-guidelines/?inf_contact_key=6bfc1257129896b6258bbfa7c2379ff334caf1526f2e0549694e91b5e5cbb49b