Breast Cancer Screening: Mammograms - Yes or No?!
Here we go again. I can barely keep up with all the cancer screening guidelines and recommendations flying around these days. On Tuesday, another breast cancer screening guideline was released by... “The US Preventive Services Task Force.” My first reaction to the story was…..wait, who's that?? I had to look up the USPSTF; I’d never heard of them.
Who is the USPSTF?
The US Preventive Services Task Force is a division in the Agency for Healthcare Research and Quality. It took a few clicks to figure out that this an agency within the U.S. Department of Health. The Task Force is made up from a remarkable assembly of medical doctors and researchers, making me wonder why I had never heard of the Force.
USPSTF’s Recommendations
Here’s a summary of their recommendations and evidence:
• The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
• The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
• The USPSTF recommends against teaching breast self-examination (BSE).
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
Unfortunately, these are the guidelines that have been passed along by the media. They forgot to include the USPSTF's "Patient Population Under Consideration Statement" that was buried further within the full report:
"This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."
The full recommendation outlines more on how the Task Force arrived at the decision and includes a very thorough list of resources and references.
The Widening Gap
The positions on screening mammography are all over the map. This issue continues to deepen the divide among breast cancer associations and further confuses the public. The question of risk seems lost in the debate among the major players in the breast cancer community. The American Cancer Society, NBCC, NCI, USPSTF, and Susan G. Komen have released statements about breast cancer screenings. You can review their policies and guidelines on their sites:
American Cancer Society: Response to USPSTF
NBCC: National Breast Cancer Coalition's Position on Mammography
National Cancer Institute: Fact Sheet
Susan G. Komen: Statement on Mammography
They all agree on ONE thing
All the breast cancer associations and medical task forces do agree on one thing:
If you're at a higher risk for breast cancer, through family history or genetics, they all recommend you
start screening mammograms as soon as possible!
Bottom Line
If you are concerned about your risks for Breast Cancer, please see your doctor. Don’t let statistics and recommendations make decisions for you. Follow your instincts and seek out care when you have questions or concerns. If you have any doubts, ask your health care provider! Komen has an excellent guide on how to talk with your provider about this important issue.
Be informed, but stay vigilant. It’s your health, your life.
As cancer activists, how can we help the cancer community develop a better way to communicate screening information? Do you think one agency or organization should be the source for all screening information?
How do you help your community understand these guidelines?
Tell me what you think!
Who is the USPSTF?
The US Preventive Services Task Force is a division in the Agency for Healthcare Research and Quality. It took a few clicks to figure out that this an agency within the U.S. Department of Health. The Task Force is made up from a remarkable assembly of medical doctors and researchers, making me wonder why I had never heard of the Force.
USPSTF’s Recommendations
Here’s a summary of their recommendations and evidence:
• The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
• The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
• The USPSTF recommends against teaching breast self-examination (BSE).
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
Unfortunately, these are the guidelines that have been passed along by the media. They forgot to include the USPSTF's "Patient Population Under Consideration Statement" that was buried further within the full report:
"This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."
The full recommendation outlines more on how the Task Force arrived at the decision and includes a very thorough list of resources and references.
The Widening Gap
The positions on screening mammography are all over the map. This issue continues to deepen the divide among breast cancer associations and further confuses the public. The question of risk seems lost in the debate among the major players in the breast cancer community. The American Cancer Society, NBCC, NCI, USPSTF, and Susan G. Komen have released statements about breast cancer screenings. You can review their policies and guidelines on their sites:
American Cancer Society: Response to USPSTF
NBCC: National Breast Cancer Coalition's Position on Mammography
National Cancer Institute: Fact Sheet
Susan G. Komen: Statement on Mammography
They all agree on ONE thing
All the breast cancer associations and medical task forces do agree on one thing:
If you're at a higher risk for breast cancer, through family history or genetics, they all recommend you
start screening mammograms as soon as possible!
Bottom Line
If you are concerned about your risks for Breast Cancer, please see your doctor. Don’t let statistics and recommendations make decisions for you. Follow your instincts and seek out care when you have questions or concerns. If you have any doubts, ask your health care provider! Komen has an excellent guide on how to talk with your provider about this important issue.
Be informed, but stay vigilant. It’s your health, your life.
As cancer activists, how can we help the cancer community develop a better way to communicate screening information? Do you think one agency or organization should be the source for all screening information?
How do you help your community understand these guidelines?
Tell me what you think!
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Comment by Ellen Rossano on November 21, 2009 at 6:06pm -
This is such a complicated issue! I had my 1st mammogram at 37 after my Mom had a small cyst. Hers popped during the needle aspiration. (Full disclosure-she smoked for 52 years and was diagnosed with tongue cancer a year after she quit. She's been cancer-free for 5 years and has never had another positive mammogram.)
My first mammogram showed a small spot, at which time I was told to wait six months and come back. I was too anxious for that; a needle aspiration popped it, and I was told to have annual mammograms.
I have "dense" breasts - lucky me. Every time I have a mammogram, they find something that requires a further look. I have had ultrasounds and digital mammograms, which have resulted in further needle aspirations, which have never produced enough fluid for testing.
The transition from film to digital showed an area of calcification that again prompted a "we don't think it's anything bad, but come back in six months." By then, I had attended the funerals of two friends from Hingham who had died of breast cancer; both had heeded that "wait 6 months" advice.
I ended up having a biopsy and was told that I have two types of cystic breast cells that will not turn into cancer. Probably.
So. Dense breast tissue. Four negative procedures in the last 10 years. Two years since my last mammogram - there is a 10-month wait at the big teaching hospital in Boston that I went to the last time. No palpable lumps - I check all the time. Paternal grandmother died of an undetermined cancer in 1959 - who knows what that was.
I just celebrated my 48th birthday, and now the recommendations have changed. I wonder what will happen if I call for an appointment on Monday? I feel like I'm a year behind, but now I might be two years early. I still might have to wait 10 months for an appointment. Is my health insurance company going to cover me? And if they find something...no, I will not wait 6 months to see what happens.
Maybe the irony here is that I am a crisis communications professional who specializes in contingency planning and worst-case scenarios. A Coast Guard vet-Semper Paratus means Always Ready. Better safe than sorry? I'll let you know how I make out.
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Comment by Ellen Hoenig on November 21, 2009 at 9:54pm -
I found these new guidelines troubling and confusing at best. After reading a few blogs and Points of Views, including John's Hopkins, my vote is to keep them where they were. The under 50 year old segment still accounts for a significant number of Dx at roughly 25%--so in my opinion, the guidelines shouldn't change! Thanks for your blog and question! Ellen
here is the link to the Johns Hopkins POV: http://www.hopkinskimmelcancercenter.org/index.cfm/cID/1684/mpage/i...
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Comment by Casey Quinlan - the Mighty Mouth on November 21, 2009 at 10:25pm
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This points up a really big gap in the health care delivery system in the US. Doctors and patients haven't been encouraged to talk to each other (other than "ask your doctor about" exhortations for Levitra, Abilify, Plavix, et al) since managed care arrived on the scene 30 years ago. Patients need to stop listening to their televisions - be it about Levitra, Hardee's Thickburgers, or US Preventive Services Task Forces proclamations - and start listening to their bodies, their family histories, and their own common sense.
Doctors, and the rest of the health care industry, are essentially chopping cotton on plantations run by big insurers and big pharma. A major paradigm shift needs to occur, driven by patients, that puts doctors and patients on the same side of the wall that traditional health insurance has built between us. This is a PERFECT opportunity for women to speak up. We're good at that, and we need to keep our voices raised that HELL NO, we're not listening to anyone but our doctors, and our own bodies.
Take it from me, kids - had I followed the new guidelines, and started at 50 with the every-two-year plan, I would have been diagnosed at Stage IV. As it was, with an annual mammogram and no family history, this Patient Zero was diagnosed at Stage IIa.
Screening mammograms cost under $150. Beat your insurer into submission if you have to. Self-pay if you have to. Find a community clinic option if you have to. But don't follow these guidelines.
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