New guidelines published by the U.S. Preventive Services Task Force are resulting in confusion and accusations of health care rationing.
The report recommends against routine mammography screening for women in their 40s, and recommends less-frequent screening for older women at average risk of developing breast cancer. The guidelines also said there was no evidence to support doctors teaching women to do breast self-exams.
The recommendations are at odds with the American Cancer Society’s guidelines, which recommend women receive annual mammograms beginning at age 40 and conduct self-exams.
Breast cancer survivor Kay Dickersin, director of the U.S. Cochrane Center and the Center for Clinical Trials at the Johns Hopkins, voted for similar recommendations concerning less screening on the National Cancer Advisory Board in 1997. She told The Washington Post she supports the recommendations because they were made by doctors who see patients and are skilled in how to interpret research data. She said all the models showed screening every other year saves just as many lives but does less harm to the body.
Dickersin also said the notion that mammograms save lives is not concrete.
“Often I hear a woman say, ‘My life was saved by because of a mammogram I got when I was 39 and breast cancer was detected,'” Dickersin said in The Washington Post article. “We cannot know that, and if one looks across many women in her age group, we don’t see that on average this would be true. She might have found the lump herself the next day, in the shower, or the cancer might have been a cancer that would not have become invasive and might never have harmed her.”
Carol Garcia, president and one of the founders of the Placer Breast Cancer Endowment, is frustrated with the recommendations. Garcia is a breast cancer survivor and stresses early detection.
“A lot of cancers are not detected through self-exams,” Garcia said. “It’s important to have these systems in place early on.”
Garcia also expressed her concern about the possible impact of the new guidelines on the health system in America.
“This is turning into a national health issue,” Garcia said. “These new guidelines could justify health insurance companies to feel they don’t have to pay for mammograms or other vital medical tests. This would force patients to be expected to pay out of pocket or not get any screening.”
Pam Phelps, associate chief of technological mammography at the UC Davis Medical Center disagrees with the guidelines.
“We’ve seen too many cancers in younger women that would have gone unnoticed had it not been for the mammograms performed,” Phelps said. “We hope that people will continue to do what they’ve been doing. Those with strong family histories of breast cancer, especially, should contact their physicians to start mammograms at a younger age.”
Dickersin believes the cost of mammograms for younger women is not worth the benefits.
“The high financial cost of mammograms for younger women is important in that if the mammograms are only marginally helpful, and are also harmful, maybe we should use the money in a different way,” Dickersin said. “For example, many people feel that we would be better off spending money on encouraging older women to get screening mammograms than paying for younger women to have them, because more lives would be saved in older women, with fewer false positives.”
Junior neurobiology, physiology and behavior major Kirollos Gendi, who is president of the UC Davis American Cancer Society (ACS) chapter, does not think the new guidelines will have too great of an effect on American women.
“There are many groups that are opposed to the regulation, including the ACS and most doctors, and most women are going to trust those sources more than the U.S. Preventive Services Task Force,” Gendi said. “It is clear that the ACS does not think that the new guidelines are a good idea, however, it is also clear that there are some dangers in excessive mammography including false positives and exposure to cancer causing radiation in quantities that far exceed that of a normal chest x-ray.”
Dr. Marion Kavanaugh-Lynch of the California Breast Cancer Research Program believes the real issue is why there are not better diagnostic technologies in the first place.
ANGELA SWARTZ can be reached city@theaggie.org.
