I expected the stories, told by breast-cancer survivors whose tumors were found by mammograms in their 40s or even their 30s. Whenever a major health recommendation is released, we tend to focus on the human stories, especially those whose lives were saved – or lost – by something relevant to that day’s news.
And I expected that there would be differing opinions. But I didn’t quite expect the level of backlash from doctors, hospitals and major health organizations, many of whom are saying they will ignore the new guidelines altogether.
Those guidelines, released by the U.S. Preventative Services Task Force on Monday, recommend that women have mammograms beginning at age 50 rather than age 40; that they have them every two years, instead of annually; and that doctors lessen their emphasis on breast self-exams. The group, a federally sponsored task force that provides guidance to doctors, insurance companies and lawmakers, said that while mammograms do reduce breast cancer deaths in the 40-49 age group by 15 percent, that number is not high enough to warrant screening every woman in that age group.
"I am that one woman who got saved because I had a mammogram at age 40," Laura Scanlan told the San Francisco Chronicle. "I can't believe it's not saving a lot of women. It saved me. If a certain number are saved, isn't that good?"
At 46, Scanlan is cancer-free. Under the new guidelines, she would not be due even her baseline mammogram for another four years, unless she was in a high-risk group of women who tested positive for the breast cancer gene or who had family history of the disease.
Stories like Scanlan’s were common yesterday (if they can ever be called common). There were also many examples of women who had found their breast lumps through self-exams and balk now at the task force’s suggestion that they aren’t important.
I am 51. Among my circle of friends and acquaintances, I know four women who have had breast cancer. Two were in their 30s; one in her 40s; one was 50. None had a family history of breast cancer. All four had surgery. Two caught their cancer early enough that surgery alone was enough treatment; the other two needed chemotherapy and radiation. Three of the four are survivors today. I wonder if any of them would be survivors without breast self-exams or mammograms, especially since three of the four wouldn’t be screened at all in the new guidelines.
"I think it's shocking to basically spell out in such a bold and callous way which groups of women they no longer care to find cancer in," said Dr. Linda Gordon, imaging director at the Carol Ann Read Breast Health Center at Alta Bates Summit Medical Center in Oakland and Berkeley.
Doctors, hospitals, advocacy groups and organizations are weighing the recommendations for themselves. A few support the new recommendations, citing the rate of mammography in the United States as compared to Europe, for example. But others are saying they will stick with the old recommendations.
“It’s kind of hard to suggest that we should stop examining our patients and screening them,” Dr. Annekathryn Goodman, director of the fellowship program in gynecological oncology at Massachusetts General Hospital, , told the New York Times. “I would be cautious about changing a practice that seems to work.”
The American Cancer Society, the American College of Obstetrics and Gynecology, the American College of Radiology and the Society of Breast Imaging all disagree with the new guidelines. M.D. Anderson, the Mayo Clinic, Baylor, Beth Israel Deaconess Medical Center and Fox Chase Cancer Center were among many hospitals that told ABC News they were standing by the old protocol.
What is your opinion? Will you personally stick with the old recommendations, or do you feel good about the new guidelines?
The San Francisco Chronicle story:
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2009/11/18/MNLT1ALVJA.DTL
The ABC News story:
http://abcnews.go.com/Health/OnCallPlusBreastCancerNews/mammogram-recommendations-meet-widespread-rejection/story?id=9109591
A CNN Health story:
http://www.cnn.com/2009/HEALTH/11/17/breast.cancer.self.exams/
A Washington Post story on the task force:
http://www.washingtonpost.com/wp-dyn/content/article/2009/11/17/AR2009111704197.html?hpid=topnews
A video of NBC’s Dr. Nancy Snyderman on the topic:
http://www.msnbc.msn.com/id/21134540/vp/34002015#33991008