A Message from Dr. Love about the New Mammography Guidelines

[Debbie L.]

Rich said:With all due respect, Debbie, I would appreciate a response to my post. If you disagree with the points, knock 'em down. No worries.

Okay. There are about 10 threads on this board about the USPSTF guidelines and I'm not sure which post you're referring to, but I'll copy/paste the one of yours that's closest to this (geographically) and have at it (smile). I just posted on this particular thread at random because I couldn't figure out which was the more active thread and they are all talking about the same things. I'll put your words in black, and mine in blue.

Rich again: Well..that scenario, process and "science" would apply to all screening at any age. But..if a slow growing tumor is found in a young woman, it could be argued it has a greater chance of killing her since it has a greater head start.

Not really. It's not the slow-growing tumors that are the big threat to life. It's the fast-growing ones, which are more likely to metastasize, perhaps even from day 1 (figuratively speaking) in their life cycle. And those are the very tumors that are LEAST likely to be found by mammography. They are more likely to found as "interval" tumors, between mammograms, noticed by the woman (or man) or her (his) partner in the course of daily life. They are typically the ones at work when you hear of a tumor springing up within a month or two of a "clear" mammogram. Yes, sometimes mammograms miss cancers but sometimes cancers grow so fast that they literally seem to appear within months - and unless one is having mammograms every few months or the timing of one's yearly mammogram is lucky - mammography is not going to help save lives lost to those aggressive cancers. This is true in all ages of women, and is part of the reason they cannot find a difference in deaths between women screened every year vs. every 2 years. And as you say, these more-aggressive tumors seem to be more common in women under 50, another reason (in addition to breast density) that mammography cannot show evidence of benefit for them.

In fact, it is pretty well established that BC in younger patients tends to be the more aggressive types. More aggressive cancer, undetected..over a longer period of time. Hmmm.

See above. If we're talking about these really aggressive cancers, the time-frame, and/or the size of the primary tumor, is of less significance than the biology of the cancer cells. We do not know nearly enough about this, but we know more than they did 20 years ago.

I remember hearing this thinking about older women years ago. Now it's being played out at the other end of the age bracket.

Not sure what you mean by that, but if you can explain more, I'll respond. You will find studies and/or researchers who do maintain that mammography isn't of benefit to anyone, any age, as far as saving lives. Probably that's a little extreme, but just the fact that they can find evidence to support that stance, in a few studies - shows us what a poor a tool mammography is, especially compared to what the life-saving attributes the awareness and screening campaigns would imply.

That's a logical (I think) way to look at it. And it also fits with people's intuition and years of PSAs. Makes it a hard sell from both angles.

Again - not sure exactly what you're getting at but yes, the issues of screening are somewhat similar, between prostate and breast cancer.

And yeah..mammography is oversold in the sense that it also has significant false negatives. I wonder how many women have taken false assurance from a negative mammo and stopped any self-exam. I forgot..those are unnecessary.

I don't know about stopping self-exam (which they are not exactly saying is "unnecessary" - they are saying that teaching a formal regimen of BSE does not save lives). But I personally know of two women who sat there for months with lumps they were aware of, because they'd had negative mammograms and so felt safe. Now did that make a difference to their outcome? Probably not, maybe so.

But..I'm glad it won't get run up the beancounter's flagpole. Might keep an eye on it anyway.

Always! Keep an eye on everything. Advocate for better answers so we can have fewer deaths. I am bleary-eyed and going to bed now but we can talk more in the morning if you want. I didn't realize you were asking the question about being "inflammatory" of me - it was someone else who accused ME of being inflammatory, not the other way 'round. When I look at the posts, they are just one after the other - no way to tell who's responding to whose post unless it's prefaced that way.

Debbie