Judy, Debbie, Kathy, Barb and Sarah. All these women are close friends of mine. All these women were diagnosed with breast cancer under age 50.
I know clinically of hundreds more and I am sure that you can name countless others who were also diagnosed with breast cancer before 50. The USPSTF is now recommending these women (under age 50) should not have received the mammogram or done the self-breast exam (in all women) that found the cancer and saved their life.
Why?
Not because cancer is the leading cause of death in women in their 40s with breast cancer being at the top.
Not because mammograms reduce the risk of dying from breast cancer by 15%, the same rate as in women in their 50s.
Not because younger women have more aggressive cancers.
Not because there are other more effective screening tests for breast cancer.
Not because 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s.
Then why did they recommend stopping mammograms for women in their 40s?
They interpreted data stating the mammograms had a small net benefit in women in their 40s. (Grade C) What does this mean? There were many false positives or a finding that required additional testing that showed it was not cancer.
Younger women have lumpy, bumpy breast so it is harder to find cancer. The current testing will have many women get additional views with a mammogram. Very few of those will require a biopsy. There will be several biopsied that are not cancer. This translates into about 5 extra biopsies to diagnose 1 case of invasive cancer. The USPSTF says that cost is too high. The American Cancer Society and the America College of OB/GYNs (ACOG) say that it is not.
SO who decides? Unfortunately with the USPSTF, it may be your insurance company that may make the decision for you. Many will only cover preventative recommendations that have a grade A or B.
So what do I do?
Write your Congress person and well as your insurance company demanding that they continue to cover preventative mammograms for women in their 40s as recommended by ACOG and the American Cancer Society.
Continue to do self-breast exams. The evidence that SBE’s help is much smaller but what is the other screening test that will find it in younger women? There is none. Recognize, that yes, I will find a lot of lumps and bumps that are not breast cancer and I may have an unnecessary procedures. You may also end up saving your life.
When clinicians look at evidence based medicine they often forget to look at the greater risks and benefits to society as a whole. What is the cost of not having a mother? What is the benefit of surviving long enough to see your children get married? What does a working 40-year-old woman contribute to society for rest of her life? Let us make the decision of risk vs. benefit! I will suffer the cost of additional mammograms and even biopsy. My family is worth it. My fear is that the USPSTF will make it impossible for women who can’t afford it, to have the same standard of care.
Save the Ta-Tas
Dr. Deb