before anyone reads this i want to make it *very* clear. if i (and many women i now know) had followed the advice of these 'new findings' we would be dead before the age of 50. there. it's as simple as that. if you are under the age of 50 and your insurance refuses to pay, fight them tooth and nail. it's your life that you are talking about!
http://seattletimes.nwsource.com/html/health/2010285760_apusmedmammogramadvice.html
New mammogram advice raises questions, concerns
For many women, getting a mammogram is already one of life's more stressful experiences.
By JOCELYN NOVECK AP National Writer
NEW YORK —
For many women, getting a mammogram is already one of life's more stressful experiences.Now, women in their 40s have the added anxiety of trying to figure out if they should even be getting one at all.
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.
[whether or not women should do self exams has been a back-and-forth issue the last few years. mainly because we aren't really taught how to do them correctly, and yes, it does result in a number of unnecessary biopsies. but wouldn't you rather have a biopsy and find out it's nothing than to not have one done and get a diagnosis of stage 4?]
The news seemed destined to leave many deeply confused about whose advice to follow.
"I've never had a scare, but isn't it better to be safe than sorry?" asked Beth Rosenthal, 41, sitting in a San Francisco cafe on Monday afternoon with her friend and their small children. "I've heard of a lot of women in their 40s, and even 30s, who've gotten breast cancer. It just doesn't seem right to wait until 50."
Her friend agreed. "I don't think I'll wait," said Leslie David-Jones, also 41, shaking her head.
For most of the past two decades, the American Cancer Society has been recommending annual mammograms beginning at 40, and it reiterated that position on Monday. "This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.
But the U.S. Preventive Services Task Force, a government panel of doctors and scientists, concluded that such early and frequent screenings often lead to false alarms and unneeded biopsies, without substantially improving women's odds of survival.
[just who is on this board? are there any women? are there any who have been diagnosed with *any* types of cancer? true, if biopsies and tests come back negative it won't improve lifespan, but WTF about those of us who came back positive? more and more women are getting mammos, and more and more are being diagnosed because of it. if all these women waited until they were 50 1/2 of them would be dead by then!]
"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chair of the panel.
Breast cancer survivors who were diagnosed at a young age were among the more vocal critics of the new guidelines.
"This sure seems like a big step backwards to me," said Debbie Hayes, who was diagnosed with Stage 2 breast cancer at age 33 after finding a lump during a self-exam. A mammogram, ultrasound, biopsy and finally a mastectomy and chemotherapy followed.
"People are being diagnosed even in their early 20s," said Hayes, now 53 and a volunteer coordinator for the Chicago-based Breast Cancer Network of Strength. "Mammograms are a key element of that."
But another breast cancer survivor thought the new guidelines sounded about right - even though she was diagnosed at age 37, two years ago.
"They seem pretty sensible to me," said Claire Mayne, of San Francisco. "The death rate is not going down because of the earlier mammograms. I'd feel comfortable telling a friend to wait until she was 50."
[this gal is, ok, i'll say it, crazy. just plain dumbshit crazy. she was diagnosed at 37. does she not get that she'd be dead by 50 if she followed these guidelines? all i can think of is that she is in deep, deep denial.]
Mayne was more doubtful, though, about the advice on self-exams; that's how she found her own cancer.
Most women in their 40s interviewed for this article said they planned to stick with the old mammography recommendations, at least for now.
[not only am i going to have a mammo every summer, but i intend on continuing with a MRI every winter!]
"I have two young children," said Amber Smart, a 47-year-old mother in Agoura Hills, Calif. "There's a lot of years left that they need me." She's been having mammograms every six months, since she was 44, to make sure that certain dense areas of her breasts aren't cancer.
[now this is a toss-up. if she's got a family history or for whatever reason had genetic testing done and found a mutation, then ok, i get it. but if she just has dense tissue and nothing else in her history i think yearly is fine]
"I think it's kind of sad that they're basically saying, 'We can't afford to pay for the few people who may have it in their 40s, so a few people are going to die,'" Smart said.
Judy Finley, a flight attendant from Dallas, called the new recommendations "a terrible idea," and said she was especially worried that insurance companies might "pick up on this and quit paying for mammograms from 40 to 50."
[a very reasonable fear indeed.]
"I think it would be really sad," said Finley, who was walking through the Crown Center mall in Kansas City, Mo. "And I don't know how the U.S. government or a panel of government officials can think they know better than the American Cancer Society."
But there were those who saw the new guidelines as potentially a relief, a development that could save women from endless stress, false positives and perhaps needless procedures.
[yes it's stressful. shit, look at what stress i went through last week and it was, according to the dermatologist eczema. but heck, i'd rather have a week of stress while tests are being run and find out it's nothing! like the people who are afraid to get mammograms because 'they hurt'. oh wah! nut up or shut up! 10 minutes of pain for a lifetime of peace! that's what you're spending and getting! - at least if it's a clear mammo. and if it turns out it's not believe me, you won't be crying over the little pain you have from the squish! you'll be crying with joy that you are still alive!]
"I can't tell you how many friends I have who've gone through severe worries from false scares," said Maren Waxenberg, a Manhattan mother. "At least three of them have had biopsies. And it turned out to be nothing."
Waxenberg herself, 46, has not yet had a mammogram. "I'm not concerned at this age," she said. "I plan to do it, but there's no sense of urgency."
The new guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations.
[here's part of the kicker. guidelines are for general population. one doesn't always know what the family history is. the mutation could be carried for several generations before blindsiding someone with cancer. i knew about 1 aunt, i had forgotten about another, and never knew about the 3rd. i'm a perfect example of what they call the general population. and if i had waited, well, i hope i had a nice headstone!]
They say:
-Most women in their 40s should not routinely get mammograms.
-Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)
-The value of breast exams by doctors is unknown. And breast self-exams are of no value.
Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years. Decades ago, the practice was so heavily promoted that organizations distributed cards to be hung in the shower demonstrating the circular motion women should use to feel for lumps.
[this is true. i still think it's better to do it and if there's anything different to have it checked out. but i do get both sides of this argument.]
As for mammography, the panel's new recommendations are more in line with international guidelines, which call for screening to start at age 50; the World Health Organization recommends the test every two years, and Britain says every three years.
They were sharply challenged by the cancer society on Monday.
"The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.
That stance "is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," he added.
But Dr. Amy Abernethy of the Duke Comprehensive Cancer Center agreed with the task force's changes.
"Overall, I think it really took courage for them to do this," she said. "It does ask us as doctors to change what we do and how we communicate with patients. That's no small undertaking."
--
Associated Press writers Marilynn Marchione in Milwaukee, Stephanie Nano in New York, Evelyn Nieves in San Francisco and Heather Hollingsworth in Kansas City, Mo., contributed to this story.
here's an OpEd piece that was printed yesterday, too
http://seattletimes.nwsource.com/html/opinion/2010290063_lynne18.html
Mammogram debate and a false economy
New government breast cancer guidelines wrongly downplay the importance of mammograms and monthly breast self-exams.
By Lynne K. Varner Seattle Times editorial columnist
Obviously, I am not more knowledgeable about breast cancer than a government-led panel of experts. Yet I know enough to look askance at advice that only women 50 and older get mammograms every two years and those in their 40s skip the test altogether.
New cancer-screening guidelines, published in the Annals of Internal Medicine, fly in the face of conventional wisdom and long-standing consensus from cancer groups, radiologists and other experts that women get annual mammograms starting at age 40.
Science routinely second-guesses itself and women have often been caught in the middle. The controversy about estrogen-replacement therapy is one example where women were forced to weigh conflicting medical advice.
Moreover, the U.S. Preventive Services Task Force isn't nixing mammograms. They acknowledge the test's early-detection benefits.
But here's what galls me: Not enough lives are saved, the experts say, to justify mammography as a routine screener for breast cancer.
[i think this is what has deep down really gotten to all of us. not enough lives were saved. so my life is nothing to them. they don't care if i live or die. forget about all my family and friends who would care - "you aren't worth it either, because nothing you say will change my mind. this person wasn't worth saving." is basically what they are saying. how does that make you feel? do you know someone who was diagnosed before the age of 50 with breast cancer? would you miss them if they had died because they were not diagnosed because they followed the new guidelines? well, tough shit. your friend wasn't important enough for us and neither are you.]
Here's a question: Of the lives saved by mammograms, which ones weren't worth the effort? Certainly my sister's life — saved not only by a mammogram's detection of something amiss, but by subsequent biopsies, surgeries and rounds of chemotherapy — was worth the effort and more.
But, says the panel of experts, mammograms' potential for harm outweigh their benefits. In about 10 percent of cases, they produce false-positive results, leading women to undergo unnecessary follow-up tests such as biopsies, and in worse case scenarios, surgery, radiation and chemotherapy.
Women are not to blame for false-positive readings. The solution is not to take away a woman's choice to have a mammogram, but rather to work to reduce the rate of false readings.
[yes!]
I can only imagine that if men were experiencing abnormally high rates of false positives on tests for testicular cancer, heads would be rolling in radiology departments nationwide.
Mammograms are not a walk in the park. I speak with experience as fresh as Monday when I rested against a chilly slab and experienced that familiar whack and intense pressure from a large machine built to flatten one's chest to the width of a slice of pita bread.
Would I prefer to forgo this experience? Absolutely, which explains why my annual exams tend to get scheduled only after a friendly, firm reminder from my physician.
[she wouldn't need this reminder if she went through a diagnosis, or even if there was something amiss that they needed to watch!]
I don't want to get mammograms. I have to. Spurring me on is not just my family narrative, but this reality: Breast cancer is the most commonly diagnosed cancer in American women, excluding skin cancer. It kills more women than any other cancer except lung cancer.
Last year, more than 182,000 American women were diagnosed with invasive breast cancer and 40,000 died of it.
If only those 40,000 women could be asked how they feel about being rescued from the trials of mammography. Better yet, how they feel about the guidelines' advice to eschew monthly breast self-exams because they have not proven to reduce mortality from breast cancer.
Adding to my annoyance is this intrusion of politics into medicine. Under health-care-reform legislation in Congress, the new recommendations would help set standards for what preventive services insurance plans would be required to cover.
Have insurance companies just been given a green light to refuse to cover mammograms for women under 50? If so, at nearly $200 a test, working women and those who are low-income have been dealt a life-threatening blow.
I know science must operate in large statistical terms but people are not numbers. If the life saved by a mammogram is my own, I am more than justified in wanting early and routine screenings.
Lynne K. Varner's column appears regularly on editorial pages of The Times. Her e-mail address is lvarner@seattletimes.com
New cancer-screening guidelines, published in the Annals of Internal Medicine, fly in the face of conventional wisdom and long-standing consensus from cancer groups, radiologists and other experts that women get annual mammograms starting at age 40.
Science routinely second-guesses itself and women have often been caught in the middle. The controversy about estrogen-replacement therapy is one example where women were forced to weigh conflicting medical advice.
Moreover, the U.S. Preventive Services Task Force isn't nixing mammograms. They acknowledge the test's early-detection benefits.
But here's what galls me: Not enough lives are saved, the experts say, to justify mammography as a routine screener for breast cancer.
[i think this is what has deep down really gotten to all of us. not enough lives were saved. so my life is nothing to them. they don't care if i live or die. forget about all my family and friends who would care - "you aren't worth it either, because nothing you say will change my mind. this person wasn't worth saving." is basically what they are saying. how does that make you feel? do you know someone who was diagnosed before the age of 50 with breast cancer? would you miss them if they had died because they were not diagnosed because they followed the new guidelines? well, tough shit. your friend wasn't important enough for us and neither are you.]
Here's a question: Of the lives saved by mammograms, which ones weren't worth the effort? Certainly my sister's life — saved not only by a mammogram's detection of something amiss, but by subsequent biopsies, surgeries and rounds of chemotherapy — was worth the effort and more.
But, says the panel of experts, mammograms' potential for harm outweigh their benefits. In about 10 percent of cases, they produce false-positive results, leading women to undergo unnecessary follow-up tests such as biopsies, and in worse case scenarios, surgery, radiation and chemotherapy.
Women are not to blame for false-positive readings. The solution is not to take away a woman's choice to have a mammogram, but rather to work to reduce the rate of false readings.
[yes!]
I can only imagine that if men were experiencing abnormally high rates of false positives on tests for testicular cancer, heads would be rolling in radiology departments nationwide.
Mammograms are not a walk in the park. I speak with experience as fresh as Monday when I rested against a chilly slab and experienced that familiar whack and intense pressure from a large machine built to flatten one's chest to the width of a slice of pita bread.
Would I prefer to forgo this experience? Absolutely, which explains why my annual exams tend to get scheduled only after a friendly, firm reminder from my physician.
[she wouldn't need this reminder if she went through a diagnosis, or even if there was something amiss that they needed to watch!]
I don't want to get mammograms. I have to. Spurring me on is not just my family narrative, but this reality: Breast cancer is the most commonly diagnosed cancer in American women, excluding skin cancer. It kills more women than any other cancer except lung cancer.
Last year, more than 182,000 American women were diagnosed with invasive breast cancer and 40,000 died of it.
If only those 40,000 women could be asked how they feel about being rescued from the trials of mammography. Better yet, how they feel about the guidelines' advice to eschew monthly breast self-exams because they have not proven to reduce mortality from breast cancer.
Adding to my annoyance is this intrusion of politics into medicine. Under health-care-reform legislation in Congress, the new recommendations would help set standards for what preventive services insurance plans would be required to cover.
Have insurance companies just been given a green light to refuse to cover mammograms for women under 50? If so, at nearly $200 a test, working women and those who are low-income have been dealt a life-threatening blow.
I know science must operate in large statistical terms but people are not numbers. If the life saved by a mammogram is my own, I am more than justified in wanting early and routine screenings.
Lynne K. Varner's column appears regularly on editorial pages of The Times. Her e-mail address is lvarner@seattletimes.com
today (wednesday) were a few more responses
on msnbc
http://www.msnbc.msn.com/id/33996346/ns/health-cancer/
Baffled by breast screening advice?
Dr. Nancy Snyderman answers your questions about the new guidelines
By Dr. Nancy Snyderman,Chief medical editor NBC Newsupdated 2:19 p.m. PT, Tues., Nov . 17, 2009
For the last 20 years, I — along with most other medical experts — have been saying the same thing over and over about screening for breast cancer
: early detection saves lives.
That advice has been turned upside down with the new recommendation issued by a government advisory panel. The U.S. Preventive Services Task Force says that most women don't need to get a mammogram until age 50, unless they have a known risk factor.
[again, *few* women really know. just your mom having it should be enough to put you into the 'known risk factor' but with these new guidelines that is made very vague.]
This major reversal in breast cancer screening advice is causing a lot of confusion and anger among women who doubt the motivation and timing of the decision.
Read on for answers to your questions about the new mammogram guidelines.
What are the real risks from starting to have a mammogram at age 40?
— Anonymous
— Anonymous
A woman in her 40s has denser breasts, which means mammography will miss some cancers because it can’t see them. Or it will see normal lumps and bumps and misread them as cancers, which can lead to further testing, sometimes biopsies, more anxiety and money not prudently spent.
[find a location with a digital machine! it's SSSOOOO much better for resolution. plus you have to factor in the experience of the radiologist who reads the films. dr watts was like, well, it could jst be breast tissue, it could be calcifications, i'm not sure. i just look at this and have a gut feeling we should do more testing. and she was right! turned out to be cancer throughout my breast!]
Mammograms are not freebies. Every time you go in for a mammogram, you get radiated and there is a cumulative effect. We’re exposing women to radiation for no real benefit for 10 years.
[saving a life is not a real benefit... yup, that's what they said]
Personal anecdotes matter, of course, but this was really looking at the hard numbers. In order to save one woman’s life in her 40s, you have to screen 1,900 women. You could conversely say you’re unnecessarily radiating 1,900 women to save one life. If you are that one life, you might say it’s worth it. If you’re one of the 1,900 women who don’t need the X-ray, you’ll say it doesn’t make any sense.
We know that X-rays over a long period of time damage cells and are their own risk factor for cancer, including breast cancer. That’s the concern here.
We have no problem telling people to get prostate screening at 50, or to get colonoscopies starting at 50. Now, we’re just saying mammography at age 50.
[but how many pre-50 year olds are getting diagnosed with these cancers? as opposed to more and more women getting diagnosed with BC before age 50...]
The scientists have been looking at this for a long time. This is not President Obama screwing with your health care. This is not the insurance lobby trying to take health care away from people. This advice is transparent scientists making recommendations based on data.
Would you recommend against having a mammogram for a 40-year-old lady with no known risk factors who asks you for one?— Aiman, Meadville, Pa.
Yes. I happen to believe that these numbers are for real. I am looking at it through the lens of my daughters. I have a 23-year-old daughter. Based on these recommendations, would I urge her to go in at 40 with no family history and no other risk factors? No.
I respectfully have changed my viewed based on the latest evidence.
I take a lot of the responsibility and a lot of the blame for being a medical correspondent and preaching early detection. The only problem was, we didn’t ask the big question: does finding tumors equate to saving lives in that 40-49 year-old age group? The answer is no.
I have learned as much from this as everybody else. But I respect the people who did the research. As painful as this is, we should applaud the transparency of science as it evolves and the fact that we have people trying to figure out the best answers for us.
The whole idea that younger women shouldn’t be screened because they’ll just be unduly anxious strikes me as rather patronizing. Why is “worry” such a concern and a reason to deny care? I know plenty of women who died of breast cancer but none who died from worrying.
— Anonymous
— Anonymous
All the talk of "worry" may sound patronizing. Although most of us don’t fret about our mammograms, there are women who are frozen with fear every time it comes up. We can’t negate the fact that fear occurs.
[ i was scared shit-less when i went in. that din't stop me from doing it though. i'd rather have to take a valium and be scared stiff - you are allowed to have someone go with you! - and find out i need to have a mstectomy to live!]
And it’s not about denying care, it’s about seeing who needs the screening and who the screening serves best? How do we protect people from unneeded radiation and yet get the women at risk in to see the doctor. If you’re 40 and have a strong family history or other risk factors, no one is going to say don’t get screened. We’re just saying, "Oh, I‘ve turned 40 and need to go in for my mammogram" is no longer the smart way to approach this.
[ i still disagree - most women do not know how high of a risk they are]
I will be 45 in two months, never had mammogram, but it does run on one side of my family. What would the recommendation be? Wait until 50 still or have at least a first one to see where I stand?
— A.L., Brooklyn, N.Y.
— A.L., Brooklyn, N.Y.
This is where you sit down and have a conversation with your physician. What kind of family history? What kind of tumors? At what age? First-degree relatives? History of prostate cancer, colon cancer?
When you have the question of family history, that’s when you individualize. That may be the greatest gift of these new parameters. What they’re are saying is, don’t spray everybody. But the people who really warrant screening, absolutely they should get it.
[exactly - how many women are going to sit down and find out all this information? i can count on 1 hand. in a perfect world maybe but this ain't a perfect world.]
How can breast self-exams be a bad idea? Why in the world would the government discourage women from doing them? It’s free and many women detect their cancer this way.
— Anonymous
— Anonymous
The yield of breast self examinations is actually quite low. No one is saying don’t do it. All the experts are saying is, it turns a woman into thinking her breast are a battle zone. It’s the monthly search and detect and most women don’t do it really well anyway.
Isn't discouraging self-exams all about insurance? How can you say it's not about the cost?
— Liz, Ridgeway, S.C.
— Liz, Ridgeway, S.C.
This isn’t about insurance. Even with recommendations, insurance policies will not change overnight. Everyone will very carefully look at these recommendations and individualize. The insurance industry was not part of this task force. These are just scientists.
It does raise an interesting question. What do we spend our money on and is this a form of rationing? These recommendations may be a form of rationing in a good sense. Just as you ration how much you eat at breakfast, lunch and dinner. You have to ration how you access the health care system. Not to be denied health care, but to spend your health care dollars prudently. Perhaps the money you save in your 40s can be invested into finding better screening tools than mammography or better cures for women who have been diagnosed. It’s to make things better, not as a way to turn women away at the door.
How about approving MRIs which do not expose us to radiation, but are quite expensive and hard to get approved by insurance companies.
Esther, Lincolnwood, Ill.
Esther, Lincolnwood, Ill.
In the 40-49 age group, they looked at digital mammography, ultrasound and MRI. It’s the same conclusion. Younger women have dense breast and they are hard to do imaging in no matter what.
It really is a message to women that — while we have politicized breast cancer and we have an awareness of breast cancer and all of that is good — we have scared ourselves into a corner.
Perhaps it’s OK for most women with no risk factors to take a collective breath. I don’t mean that in a patronizing sense. It’s just that we all feel the pressure of what we think is going to befall us.
Perhaps it’s OK for most women with no risk factors to take a collective breath. I don’t mean that in a patronizing sense. It’s just that we all feel the pressure of what we think is going to befall us.
Heart disease is a still bigger issue and we are not as militant about heart disease as we are about breast cancer.
[what i wonder is: we had all this talk about health care reform. insurance and doctors were told to cut costs. so a group of people get together and asked 'how do we cut costs?' answer: delay regular screening mammograms by 10 years. then change it to every other year instead of every year. right there we've saved how many oodles of dollars?]
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