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Get ready for a fight.
In a move that certainly came as a surprise to many, new recommendations by a panel published yesterday now recommend that regular mammograms start at 50, not 40 for most women. They also said that women should have mammograms every two years, not every year, from ages 50 to 74. And that breast self-exams may basically be useless.
The recommendations are made in hopes that women will avoid overscreening, unnecessary biopsies and needless anxiety. And it is based in scientific study of when most cancers are found, how aggressive they are, and how successful treatment turns out to be.
But it more likely leaves us conflicted over what it is exactly we’re supposed to do. And it worries some that coverage for annual mammograms for younger women could be dropped by insurance plans.
The American Cancer Society and M.D. Anderson, among others, disagree with the new recommendations.
From the New York Times:
“Just seven years ago, the same group, the United States Preventative Task Force, with different members, recommended that women have mammograms every one to two years starting at age 40. It found too little evidence then to take a stand on breast self-examinations.
“The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services.
Its new guidelines, which are different from those of some professional and advocacy organizations, are published online in The Annals of Internal Medicine They are likely to touch off yet another round of controversy over the benefits of screening for breast cancer.”
The new guidelines do NOT apply to women with a higher risk of breast cancer, especially those who have had genetic screening for the breast cancer gene. Primarily, the hope is that each woman will discuss with her own doctor the pros and cons of having mammograms before age 50.
“We aren't against screening women in their 40s, we just don't think it should be routine,” said Dr. Diana Petitti, vice chair of the task force. "All we are saying is, at age 40, a woman should make an appointment with her doctor and have a conversation about the benefits and harms of having a mammography now versus waiting to age 50."
From CNN Health:
“While roughly 15 percent of women in their 40s detect breast cancer through mammography, many other women experience false positives, anxiety, and unnecessary biopsies as a result of the test, according to data.
“But the updated guidelines don't come without controversy.
"With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them," said Dr. Otis Brawley, chief medical officer for the American Cancer Society.”
“The organization says it looked at virtually the same data as the task force but came to a different conclusion. "Breast cancer is a serious health problem facing adult women, and mammography is part of our solution beginning at age 40 for average-risk women," it says. It recommends annual exams beginning at that age.
From The Los Angeles Times:
“Oncologists were nearly uniform in their disparagement of the guidelines, fearing the loss of a valuable cancer-prevention tool. Women in their 40s account for at least a quarter of breast cancer diagnoses.
"I think it is unfortunate that they came to this conclusion," said Dr. Angela Sie, director of imaging at the Breast Center at Long Beach Memorial Hospital. "It would be a huge step backwards for women's health in this country."
“And other groups that issue guidelines about screening and prevention, such as the National Cancer Institute and the American College of Obstetricians and Gynecologists, immediately attacked the federal panel's conclusion, saying that they would not change their guidelines and would continue to urge women to undergo the tests.
“Insurance companies and Medicare administrators, which normally follow the panel's guidelines closely, said they would continue to pay for the procedure -- although it is not clear how long they can resist the panel's influence.”
The New York Times story:
http://www.nytimes.com/2009/11/17/health/17cancer.html?_r=1&hp
From CNN Health:
http://www.cnn.com/2009/HEALTH/11/16/mammography.recommendation.changes/index.html
From The Los Angeles Times:
http://www.latimes.com/news/nationworld/nation/la-na-mammogram17-2009nov17,0,3942708.story
What about you?
What are your feelings about these new recommendations? Do you agree that women are having too many mammograms at too young an age? Or do you worry that cancers in those under 50 will go undiagnosed?
We’d love it if you’d share your personal experiences. How old are you, how many mammograms have you had, and how do you feel about yesterday’s panel recommendations?
Add a Comment8 Comments
By this task force rasing the age to 50 for women to start getting mammograms, they have made it easier for insurance companies do deny paying for this procedure for women in their 40's. This is the start of government rationing health care and if you don't believe this see who comprises this task force.
November 23, 2009 - 5:44pmIt is an absurdity for this task force to state that it is too risky for woman to get mammograms in their 40's. Just talk to a 40 something woman fighting breast cancer and see what she thinks.
This Comment
Fight? More like battle or war. I heard this on the news 2 days ago and I honestly don't know what to make of it. I have no family history of breast cancer so I guess I will not be examined for breast cancer until I am 50-- that is, if I make it till then.
I don't really understand why they do this. If no family hx= no breast cancer then I would agree, but it certainly does not. I will continue to perform a self breast exam in my shower once a month. I don't see the harm in it at all.
November 18, 2009 - 6:39amThis Comment
Don't know what to make of it? The purpose is to cut healthcare costs that's why these changes are happening. Not only women but men should be angry as well.
November 20, 2009 - 8:26pmThis Comment
Rosa,
In fact, most breast cancers are found in women with no history of breast cancer in their families.
For right now, most doctors, hospitals, breast cancer authorities and even Health and Human Services Secretary Kathleen Sebelius all say that the older recommendations are the ones that should continue to be followed. And USA Today had an article this morning in which they interviewed many of the biggest insurance companies, who said that (at least for now) annual mammograms will still be covered for women in their 40s. A link to the update:
https://www.empowher.com/news/herarticle/2009/11/19/will-your-insurance-company-still-cover-annual-mammograms-age-40-so-far-m
November 19, 2009 - 9:13amThis Comment
Hi Diane - Get ready for a fight? Indeed.
The volume of and variety of voices coming out on this topic has been really interesting. While there are certainly many sides to this, the real issue is that not enough is being done to help women help themselves in making the right moves to prevent and detect all cancers including breast cancer. This has only been an openly discussed topic for about 30 years and we need more information, not a dictate that reduces access to screening tools or forces women to self-identify as at high-risk for breast cancer and therefore increase their insurance premiums.
As a woman whose breast cancer was detected and treated successfully in my 30's, and who knows other women whose cancer was found via mammograms before the age of 50, I'm truly appalled at how narrow and confusing the information coming out on the recommendations has been. Experts say that the majority of women diagnosed with breast cancer have no family history of the disease, so the advice to wait until age 50 for screening could mean a death sentence for many women. This reminds me of the "old" days when women were told to do what they were told, and many of the things we were told to do were actually harmful. This discussion is far from over and there are many fights still to come in the days and weeks ahead.
November 17, 2009 - 6:10pmBest regards,
Pat
This Comment
I actually tend to agree with this. There is a lot of risk from xrays in general. Screening is only routinely done after 50 in most European countries. A lot of women get little cysts and lumps which are benign and often end up having breasts removed unnecessarily and even have unnecessary chemo, etc.. which CAN kill. A theory amongst the holistic community is that it is not always cancer that kills people, but the "cure". Removing a lump may cause worse problems in other areas of the body, according to naturopaths.
November 17, 2009 - 11:47amThis Comment
Really? Then move to another country to experience the downside of the absence of preventive medicine and you will notice that no other country other than the US has a high catch/cure cancer rate of 98%. Beat that! Get some common sense please...
November 20, 2009 - 8:24pmThis Comment
To the poster above. Of course it is done only over the age of 50 in Europe, most of those countries are on a nationalized health care plan. (which ironically and unfortunately we are heading towards) We have the highest success rate of cure in the world and that is due to early detection and the health care that we have! People COME here to get cured.
November 17, 2009 - 4:31pmThis Comment