Nafisa Tejpar, MD, FACS
The USPSTF Mammogram Screening Guidelines Controversy Continues Into April, 2015
In November 2009, the U.S. Protective Services Task Force issued recommendations about when women should receive mammograms and ignited a controversy. In April, 2015 the same group just came out with another report recommending the same things. This recommendation may jeopardize the lives of women and the ability of women under age 50 to obtain mammograms unless they pay out of pocket.
I join many others, including the American Cancer Society, the Susan G. Komen for the Cure organization, the Mayo Clinic, The American College of Obstetricians and Gynecologists, The American Society of Breast Surgeons and others in strongly disagreeing with the USPSTF. Their mammogram screening guidelines will cost lives and for some women, waiting will ultimately reveal much more aggressive disease at the time of diagnosis.
Mammography screening is not perfect, but it is the best tool we have right now to save lives. It does not detect all cancer, but with newer digital mammography, we are better able to detect it.
The basic recommendations of USPSTF remain that mammogram screening women 50-74 years old every 2 years and that women 40-49 should discuss it with their doctor. They made no recommendations for screening over age 75 which is the time of highest risk and the time when mammography can detect most clearly any cancerous growth. Part of their concern is that regular screening under age 50 would increase the number of biopsies which turn out to be benign. That is likely true. Because more irregularities will be found if people are screened, some of those will be benign.
You may think that I recommend annual screening at age 40 simply because I am a breast surgeon. I do biopsies to determine for sure whether a lump or suspicious area on a mammogram is malignant. But I want to make clear that even if I stopped doing surgery tomorrow, I would still want the women in my own family and my own friends to do regular mammograms starting at age 40. I cannot stress enough how important regular screening mammograms are. Now with the digital imagining, the quality of mammograms has improved dramatically.
I have seen women 40 years old (and younger) with aggressive cancer who would have died if they had not had regular mammograms. I have seen women in their 50's and older who have had several years of negative mammograms only to have cancer found on a routine screening mammogram when they least expected it. I have seen women in their 70s and 80s who are healthy and active in every way find breast cancer through a screening mammogram. With breast conserving surgery and radiation most who detect cancer early can go on to live full, active lives. Others will need more extensive treatment.
The breast cancer screening group at Loyola University Health Systems agree that it is dangerous for women to wait until they are 50 based on these new recommendations. Dr. Kathleen Ward, director of women's health imaging and breast imaging states: "Screening women beginning in their 50s every other year would lead to a much greater risk of advanced stage disease at the time of diagnosis." (4-2015)
Dr. Davide Bova of Loyola system's radiology services adds: "These guidelines create a potential financial barrier to a woman's right to decide when she wants a mammogram. If a screening mammogram becomes an out-of-pocket expense due to these recommendations, countless lives will be lost."
Early detection saves lives, reduces the need for chemotherapy and can increase the chance of breast conservation for women of all ages. Since the 1960's when they began pushing regular mammogram screenings, although more cancer has been found from early detection, the United States breast cancer death rate has dropped 35%.
Therefore, I strongly oppose these publicized guidelines and just as strongly support the current recommendations of the American Cancer Society and The American Society of Breast Surgeons and the American College of Obstetricians and Gynecologists.
"Their recommendations could lead to insurance companies dropping coverage of mammograms for women under age 50, as well as other preventive techniques that would help protect young women from getting breast cancer and help those who do have it.
This is a wrong and dangerous path to take.
For me, this is a deeply personal fight. In 2007, at 41, I discovered a lump in my breast that turned out to be cancer. I didn’t find this tumor through luck, I found it because I knew about the risks that cancer poses, and I knew that I had the responsibility to follow guidelines about my breast health --guidelines that ultimately may have saved my life. . . .
And most staggering of all: On the same day these draft recommendations became public, the National Cancer Institute announced that the total number of breast cancer cases in this country will rise by 50 percent by 2030."
Mammography remains an imperfect, but essential tool for early detection of breast cancer when it is most easily treated. Sometimes mammograms find suspicious areas that are discovered to be benign through biopsy. Mammograms sometimes miss certain cancers, but the rate of detection is improved now with the use of digital mammography (which is used at many Orlando area women's imaging centers.)
Some women avoid mammograms because they are afraid it will hurt. For most women there is only minimal discomfort, if any, for a few seconds due to pressure when they press the breast. Breasts can be more sensitive before your period and some women have more sensitive breasts. Even if it is uncomfortable for you, the pressure lasts only seconds and can save your life!