New Proposed Changes to Mammogram Guidelines

[lizm100]

Task Force Recommends Drastic Changes to Mammography Guidelines

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Page last modified on: November 16, 2009
"The recommendation to change screening is a huge step backwards," says Dr. Marisa Weiss.



To the Breastcancer.org community:
The U.S. Preventive Services Task Force recently recommended dramatic changes to current breast cancer screening guidelines. Breastcancer.org is strongly opposed to these recommendations.
The proposed new guidelines recommend starting regular screening mammograms at age 50, rather than at age 40 as current guidelines recommend. They recommend screening before age 50 only for women with a much-higher-than-average risk of breast cancer. The proposed new guidelines also call for mammograms to be done every other year instead of every year, as recommended by current guidelines.
The proposed new guidelines are based on research that looks at the effect of breast cancer screening on society from a public health perspective. This means the researchers were looking at how changing breast cancer screening guidelines would affect the overall public, rather than individual women. In proposing the changes, the task force members said that starting mammograms later in life and doing mammograms less often would save a large amount of money. It also means that about 3% more women would die from breast cancer each year. The task force members felt that the amount of money saved (from fewer mammograms and side effects of extra biopsies and treatment) was greater than the value of more lives saved (3% fewer women surviving breast cancer).
At Breastcancer.org, we are deeply troubled by both the analysis that led to these proposed guideline changes and the effect these proposed changes would have on the health and lives of women. Our specific concerns:

• The analysis was based on older mammography techniques, meaning the researchers mostly looked at results from film mammograms instead of digital mammograms.
• The analysis was based on some inaccurate assumptions about optimal treatment after breast cancer is diagnosed. For example, it assumed that women diagnosed with hormone-receptor-positive, early-stage breast cancer would receive and benefit from hormonal therapy but not chemotherapy, even though we know that many of these women do receive and benefit from chemotherapy after surgery. Inaccurate assumptions like this may have caused the researchers to underestimate the number of lives that would be lost should the proposed changes in screening be adopted.
• The analysis did not adequately consider the combined benefit of early detection (with current screening guidelines) and new treatments that have resulted in steadily improving survival rates in recent years. Screening cannot be looked at in isolation as a snapshot. Screening happens as we continue to improve both diagnosis and treatment. But we can’t treat what isn’t diagnosed.
• The proposed guideline changes would mean that many breast cancers would be diagnosed at a later stage, making it harder to become cancer-free. Later-stage diagnoses result in more women with metastatic disease (that has spread to other parts of the body) and more women with large or multiple cancers requiring mastectomy (too late for breast-conserving treatments).
• The proposed guideline changes would mean that younger women would be diagnosed later. Breast cancer in younger women tends to be more aggressive, so early diagnosis and treatment is more critical for them. It is the lives and futures of younger women that would be lost if the proposed changes are adopted.

Expressed as nameless, faceless numbers, the 3% decrease in breast cancer survival might seem like an acceptable trade-off when compared to the economic benefits of changing breast cancer screening policies. But breast cancer affects a very large number of women, so 3% of that number is not insignificant. The reality is that more women -- mothers, daughters, sisters, grandmothers, and aunts -- will die each year from breast cancer, which is neither reasonable nor acceptable.
We at Breastcancer.org encourage medical professionals and everyone affected in any way by breast cancer to raise their voices against these surprising and dramatic proposed changes in the guidelines for breast cancer screening. Our belief is that lives should be saved, not lost, and our commitment to you is that we will continue to strongly advocate for policies that support this fundamental mission.
Marisa C. Weiss, M.D.
President and Founder, Breastcancer.org
Director of Breast Radiation Oncology, Director of Breast Health Outreach
Lankenau Hospital
Maxine Jochelson, M.D.
Director of Radiology
Evelyn H. Lauder Breast Center
Memorial Sloan-Kettering Cancer Center
Professional Advisory Board, Breastcancer.org
Emily F. Conant, M.D.
Professor of Radiology, Chief of Breast Imaging
Hospital of the University of Pennsylvania
Professional Advisory Board, Breastcancer.org

[Joe]

Is there anything on the Young Suirvivors Board about this?

Regards
Joe

[Jackie07]

New Mammography Guidelines for Women

Women in Their 40s Should Discuss Risks, Benefits With Doctors, Says Physicians Group
By Miranda Hitti
WebMD Health News
Reviewed by Louise Chang, MD



April 2, 2007 -- The American College of Physicians today issued new mammography guidelines for breast cancer screening for women in their 40s.
The guidelines boil down to this: Women in their 40s should work with their doctors to gauge their personal breast cancer risk and to decide whether to get mammography to screen for breast cancer.
If a woman in her 40s decides not to get a screening mammogram, she and her doctor should revisit that decision every one to two years, states the American College of Physicians (ACP).
In short, the ACP isn't making a one-size-fits-all recommendation. Instead, the ACP says the decision should be tailored to each individual woman in her 40s.
"No simple recommendation applies to all women in their 40s," states an editorial published with the guidelines in the Annals of Internal Medicine.
The guidelines only apply to routine screening mammograms, not diagnostic mammograms taken of specific breast lumps or other breast findings.
Mammogram Studies

A team of experts reviewed 125 mammography studies for the ACP. They included Katrina Armstrong, MD, MSCE, of the University of Pennsylvania.
"Screening mammography probably reduces breast cancer mortality in women aged 40 to 49 years modestly," write Armstrong and colleagues.
They note that many women in their 40s will choose mammography for that potential reduction in breast cancer death.
However, Armstrong's team notes that screening mammograms likely save more lives in women aged 50 and older, since breast cancer becomes more common with age.
In addition, mammograms aren't perfect. They may miss a tumor or flag a benign breast lump, leading to more tests and anxiety.
Mammograms also deliver a low dose of radiation, and it's not clear what the long-term consequences of that may be over a lifetime, note Armstrong and colleagues.
Many women find the mammography procedure uncomfortable. But in the reviewed studies, few women said mammography pain would stop them from getting a mammogram.
Personal Decision

Women's breast cancer risk depends on age, family history, and many other risk factors.
A woman in her 40s should gauge those risk factors with her doctor and decide how she feels about getting mammography to screen for breast cancer, notes the ACP.
"Because of the variation in benefits and harms associated with screening mammography, we recommend tailoring the decision to screen women on the basis of women's concerns about mammography and breast cancer, as well as their risk for breast cancer," write Armstrong and colleagues.

[StephN]

I, for one, was horrified, that this is just a sneak peek at things to come. They are preparing for a national health plan that will give much less access to screenings and hurt mostly the rising number of younger breast cancer patients.

Defintely a step backward, IMHO. Especially since we now have digital mammograms which have much less radiation exposure.

[Jackie07]

"Women in their 40s should work with their doctors to gauge their personal breast cancer risk and to decide whether to get mammography to screen for breast cancer."

Are you kidding me?

My first breast cancer was felt 30 hours before the 'routine' mammogram. I was 43, with no family history of breast cancer.

My recurrence was 'not' found in any of the following mammograms because the cancer was deemed 'scar tissues'. Again, it was caused by 'human error' - the doctor who read the x-ray made the false interpretation ('assumption'?) - and not the fault of mammogram itself.

Mammogram saves lives. It needs to be improved instead of dropped for women between 40 and 50 which, by the way, is one of the peak age for breast cancer incidents. It is not right to place the responsibility on the women to gauge their own risk factors and 'work with' their doctors to get the test.

Can't help but begin to wonder if there's an 'agenda' behind this new guideline since more women (and men) are going to be covered under the health care reform...

[Sandra in GA]

No self breast exams; mammograms only for the 50 and over. Only those "at risk" are to be tested before age 50. Maybe they have not read that 85% of women who are diagnosed with breast cancer have NO family history of this disease. (That was in some of the information I was given at Mayo Clinic at the time of my diagnosis.) Women who have mothers, grandmothers, or aunts with BC are in the minority. Only 15% have family history. Decreasing the mammograms to only 15% of the women between 40 -49 would decrease the cost, but at what cost?

I am in the majority of people diagnosed with breast cancer by having NO FAMILY HISTORY. Why isn't this fact better publicized? Is it because it would cost too much for more women to be more diligent about mammograms?

Mammograms are not perfect. Breast MRIs are much more reliable, but they are very expensive and not readily available. They should be pushing for more reliable mammogams or other tests instead of pushing to eliminate the test that is the standard now.

[lizm100]

I have no history of breast cancer and I am the youngest of 6 girls. If it wasn't for digital mammography, my cancer would have not been caught at the age of 38 at a very early stage. I had no lump but a thickening that only I felt. Due to my being persistent (after 2 visits) my doctor finally ordered a mammogram. At worst case with the present guidelines, I would of had to wait till the age of 40 for a mammogram not 50! I don't want to imagine what would have happened to her2+++ cancer 12 years later.

[RhondaH]

Joe,

Here is a link to the discussion on Young Survival.

http://www.youngsurvival.org/bulletin-board/

[RhondaH]

I'm STUNNED!!!! I was 40 when I was diagnosed by my 1st mammogram (neither surgeon or I could feel it), which was HER2+. Listening to the radio this AM, Dr. Susan Love is in FAVOR of the new guidelines...

[suzan w]

Terrible news...I wonder how much the insurance companies paid for this study?? My tumor was found in a mammogram, and all doctors agreed that Invasive Lobular Carcinoma is rarely found in mammograms because of the nature of the "beast"...ILC does not usually form a tumor but spreads single cell through the bloodstream. I am alive today thanks to a mammogram. No family history either, yet, after 4 years of thinking BRCA tests would be a good idea, and denial from WA Blue Cross, finally got the BRCA approved in NM and...it was positive...Go Figure. This new study is indeed a scary view inito the future of Women's Health (and Men's too because the next study will probably show that men don't even get BC). Fed Up!!! xo Suzan

[Laurel]

Last February or March, soon after the new administration entered office, this suggestion to reduce the frequency of mammograms, and to raise the age threshold was floated. I recall seeing it disseminated via the sycophant media repeatedly over a period of approximately a month. At the time I wondered just how stupid the government thinks we are? I saw this coming months ago. It is a harbinger of what is to come under ObamaCare. God help us all.....

Do not have daughters.....

[nitewind]

I couldn't believe it when I read this....
"
A government task force said Monday that most women don't need mammograms in their 40s and should get one every two years starting at 50 — a stunning reversal and a break with the American Cancer Society's long-standing position. What's more, the panel said breast self-exams do no good, and women shouldn't be taught to do them."
Why are we taking backward steps?

[duga35]

This is #@#!!####!

I know that we aren't supposed to talk about politics here, but to me this is pretty clear cut on the things that the present administration is trying to do to us.

Cleveland Clinic and MD Anderson both told me to make damn sure that my daughter starts yearly mammograms @ age 20 because when a father has MBC that throws up a huge flag for daughters.

I believe that you'll start seeing them say that stage IV patients are terminal so why waste so much money much on them.

Good God I pray that I'm wrong but I think this is just the beginning.




I'm sorry and forgive me, but this has made me freaking mad as hell

[Jaimieh]

I think this new guideline is just a load of crap. I guess by the new guideline I would have never known that the lump in my breast was there because you are not supposed to do your SBE. You know young women (I was 32 at diag.) do not get breast cancer (dripping with sarcasm). I hope the people who came up with it NEVER have someone in their family diagnosed earlier than 50. I have avoided the news because it makes my blood boil.

[Faith in Him]

Can't believe it either. I have no family history and was 37 at dx. What are they thinking?

[Patb]

What can we do???? Are they crazy? My breast
cancer was growing so fast, I was just lucky I
never missed a yearly mammogram. Who are
these people?
patb

[flynny]

Hi Joe, I tried sending this last night on my blackberry, but it timed me out (so frustrating). I am a young survivor! As you can see by my signature below I was dx at 34 (should have been 33). My story as some of the women and men have heard me talk about goes like this... My mother was dx at 54 and there was NO FAMILY HISTORY of BC, so they said I should NOT start having mammo's until 40. I was 31 when I was told this and just 2 years later I found my lump. When I say it popped out over night, it did. However,when I went to see my PCP (who was about my age) said "I think its a cyst" and knowing my mother had BC she did NO FURTHER tests!!! Hold on it gets better....My mother was dx about 2 mos later w/ a 5 cm brain tumor (the radiologist mis-diagnosed her 2 cm brain tumor just 5 mos prior - another story). After focusing my time toward my mother and taking her to all of her appointments, it was now Nov '07 and I found my bras to be stained. So I made an appt. w/my OB-GYN (but her colleague saw me instead). I'm in her office explaining my insane life I was living and that my mother's cancer had mets and she would most likely die within a short period of time. Well after examining me and seeing that the discharge coming out of my right breast she said "I think you have fibrocystic breast change and that I should take 400 IU Vit E 2 x/day. I still have the post-it note she wrote on. I could go on and on. My mother had very dense breasts and I only wish I knew what that meant years ago. If she only had an ultrasound they would have seen it earlier. She had seen her OB-GYN just a couple of months prior to her finding her nipple indented. This whole thing makes me so sad, mad and disappointed in a number of doctors. We are not a statistic. WE ARE INDIVIDUALS!!! I also want to share with you my story that I got to share with my local magazine. Go to www.parentingnh.com. They messed up my staging (which I clarified with the reporter). I also joined our local YSC Manchester, NH group. It is important to let young women know that this could happen to them!

[ElaineM]

Are we starting some kind of group petition to send somewhere? I will sign.
I know several women under 40 in addition to some people on this board who were diagnosed with breast cancer.
I heard one comment on the news this morning about mammograms not being able to detect things under 1 cm and it could take years for tumors to grow to 1 cm.
Are women supposed to sit around and wait a few years for tumors to grow until they get to 1 cm, so they can be tested?
The comment also claimed that women can't find things smaller than 1 cm. Then how come I correctly found malignant tumors close to the surface of my breast skin that were only 1 or 2 mm? My fabulous dermatologist removed them after my oncologist refused to do anything about them. The pathology reports all came back positive for breast cancer.
The point should be to get rid of problems while they are still small if possible.
If mammograms can't detect small problems then researchers need to develop some kind of better testing method that can detect small problems instead of leaving thousands of women without methods of detecting breast cancer.
I lost respect for Dr. Susan Love.

[margiermc]

Go to www.ahrq.gov/clinic/

Then go to Clinical Information and click, Preventive Services
The U.S. Preventive Services Task Force, aka USPSTF
www.ahrq.gov/clinic/prevenix.htm
click contact us - www.ahrq.gov/info/customer.htm
go to Frequently Asked Questions -
http://info.ahrq.gov/cgi-bin/ahrq.cf...er/std_alp.php

See questions 1-11 and read answers

This is all under the government branch of the Federal Agencies and Commissions - www.hhs.gov - The U.S. Department of Health and Human Services

The Sec. of this department Kathleen Sebelius made an announcement that this is an independent panel of doctors, scientist and researchers and not under any gov't dept.,
I found it all under her department -

This is not a political issue, but there is some problems with a panel that decides new guidelines and is selected under a government department.

[Laurel]

What can we do? Contact your congressmen. Email the White House (not that they will give a damn, but do it anyway) and then...VOTE in the next election.