No mammograms until 50?

In My Humble Opinion
1

The US Preventative Services Task Force has come out with new guidelines for breast cancer screening, saying mammograms do not need to be done until age 50, that self-exams do not work, and women over 74 do not need mammograms.

As a breast cancer survivor who was diagnosed at 40 after a routine mammogram, I shudder to think what would have happened if I had waited until 50. A friend of mine discovered a lump in her breast when her husband felt it. There is an 80 year old breast cancer survivor in my support group.

So a reduction of 15% isn’t enough?

The American Cancer Society and other groups have denounced the new findings. All I can say is I don’t know if I’d be alive if I’d waited until 50. My sister in law was just diagnosed (she’s having surgery on tomorrow) and she’s 49. Her cancer is aggressive…what would have happened if she’d waited until next year?

2

I wonder if that Task Force is an offshoot from the insurance industry.

3

There was one other recommendation, which is that women have a mammogram every two years instead of every year. I have no idea how I feel about this one. On the one hand, clearly, lives are saved for that portion of women between 40 and 50 who have breast cancer. On the other, this is in keeping with idea that people in this country are over-screened and that many people don’t benefit from it, with detection rates for cancers going up but survival not improving, which means you get the harm of biopsies that come back negative, or radiation or chemo when they come back positive, but no benefit in survival. I would say that ideally we need to develop better ways of finding which cancers need to be treated immediately and which ones don’t.

4

*Reader’s Digest *had an article about this a few months ago…about women in (Norway? Sweden?) where mammograms were less common. It was found that a certain percentage of the women who died had breast cancer, but it wasn’t the cancer that killed them, implying that breast cancer need not necessarily be fatal.

Still, if I had it to do over again, I’d go through everything again, just to know the ladies were Cancer Free.

kiz, there are some people that are speculating this could be the beginning of rationed health care. I’d rather table that discussion for another thread and keep this one just for whether the panel’s findings are sound.

5

I want to see some good public debate on this. (From the medical community) I’m not ready to jump on the bandwagon that says: “Oh this is terrible!!” just yet.

6

I know mammograms are not the end all and be all. After they found “something,” I had an ultrasound and a biopsy, then a breast coil MRI.

So until we get the Star Trek type scanners, I think we need SOMETHING that will allow us to look for things that may or may not be normal.

7

Doesn’t look that way. You can read more about the task force and see its membership here.

The AHRQ is part of the Department of Health and Human Services.

8

As the sister, daughter and niece of women who’ve had breast cancer, I think this is assinine. In the end, it’ll be used by insurance companies to refuse to pay for screening mammograms. Presumably, since I’ve had them since my late 30’s (whatever happened to the concept of a baseline mammogram early on - are those no longer recommended, too?) and often then have to have diagnostic mammograms every 6 months or so, I’ll still be covered.

My worry is if fewer mammograms are performed, the technology to refine the images and improve technology will slow down.

This taskforce might not be a pawn of the insurance companies, but you can be sure the recommendations put forth will be given a great deal of weight, especially whe it will save both the insurance companies and Medicare/Medicaid money.

StG

9

It won’t save Medicare very much money, since very few people are eligible for any Medicare benefits before age 65. It won’t save Medicaid much money either, since they’re only partially covered in most states and very few people who are Medicaid-eligible can afford the out-of-pocket cost of services which are not fully covered.

It will certainly save the insurance industry lots of money.

A friend of mine runs a local breast cancer charity and support group, Libby’s Legacy, and she was absolutely fuming about this yesterday.

10

They’re not saying that women under 50 can’t have mammograms, they’re saying that the results do not indicate that a mammogram under 50 is not helpful, and often a waste of resources, excepting those who have a family history or other early indicators.

You can have as many mammograms as you want - you just have to pay for them. I see this as a good thing, because a demand will spring up, and the cost of mammograms will be driven down. A smart person will start a company giving and interpreting mammograms for cash. This has already gone on with other types of “x-ray” screenings, and prices have gone down.

So, hopefully, in the future, if you want a mammogram, you can get the $150 screening at the radiology clinic, pay cash out of pocket, and stop pissing away the resources of the other people in your insurance pool.

11

Hmm…

You know, most of the rest of the world follow “screen over 50, every two years” guideline already (or so I’ve been told) so I suspect some of this is “everyone else does it this way.”

Also - I’m assuming they’re referring to screening the general population. Women at known high risk might well still be considered for earlier screening. Women with many relatives with breast cancer, history of early breast cancer in the family, or with known breast cancer gene susceptibility.

On the other hand, there are women such as myself where there are NO blood relatives with breast cancer on either side of the family and an overall very low risk of cancer (I’ve had two relatives with cancer, one of which has been in remission for over 50 years). Frankly, I am MUCH more worried about my risk of heart disease, which runs rampant in my family. Yes, yes, I realize that I could be the first to get breast cancer and I did get a baseline - in my 40’s. I keep an eye on the girls, but honestly, like I said, it’s heart disease I’m most concerned about.

As always, your mileage may vary - and probably will based on family and personal history.

On the end point - my mother ceased to be screened for breast cancer before 74. Why? Because heart disease had so debilitated her that there was no way in hell she could survive even one round of chemo or radiation, in fact, it was unlikely she’d survive any form of surgery, either. So why bother? If the treatment would kill her faster than the cancer (and it would have) there’s no point to screening. If she had been found to have cancer the only treatment possible would have been palliative care anyway, and that could have waited until she was more overtly symptomatic. As it happens, she died without ever developing cancer. It was the heart disease that got her - like I said, it runs rampant in my family.

So really, it makes sense that SOME women should be screened very early, in their 30’s, while for others the risk is so much lower that waiting until 50 is probably not unreasonable. And if the woman is so debilitated by other condition(s) that it wouldn’t be possible to treat breast cancer if it was found there really is no use for screening before actual symptoms. To my mind the biggest problem is slapping a blanket recommendation on everyone without regards to a personal risk assessment and considering the patient as a whole.

12

Demand for mammograms will increase because insurers stop paying for them? Yes, that makes perfect sense.

Do you think demand for asphalt would increase if the government decided to build fewer roads?

13

put me down as someone who thinks this is total shite … 15% is not bad. If it was 1% I could see - but I would be willing to bet that if it was a male health issue, there would be no similar recommendation.

Not trying to sound feminist, but sometimes the health world is male dominated and really does not have the woman in esteem. Look how much argument there was at medicating women for pain in childbirth. Look how long it took to legalize birth control, and abortion. And look at the nonsense about bleeding once a month when it is not medically indicated ‘just so women can feel feminine’. Look how long it took to get female doctors.

14

There is a harm associated with mammograms- false positives do exist, as well as the harm from aggressive treatment of indolent and non-lethal disease, and mammograms do not save as many lives as you might believe.

The research on the harm of breast screening is fascinating reading.

Of note, from my cite:
"If 2000 women are screened regularly for 10 years, one will benefit from the screening, as she will avoid dying from breast cancer.

At the same time, 10 healthy women will, as a consequence, become cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy and sometimes chemotherapy

Furthermore, about 200 healthy women will experience a false alarm. The psychological strain until one knows whether it was cancer, and even afterwards, can be severe."

15

If you’re interested, you can read the full recommendation statement and rationale for the decision at http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm

16

I had no history of breast cancer in my family.

I don’t smoke and I exercise regularly. So I’m not considered “high risk.”

I still had a tumor in my breast caught with a mammogram. Under these proposed guidelines, I’d still have it for another eight years, unless it grew so large as to be noticeable.

17

Never so happy to have “breast cancer in my family young” as I was yesterday.

My nurse practitioner was talking about BSEs. She said “yeah, BSEs aren’t that useful - regularly touching your own breasts - or having someone else touch them for you - IS.” In other words, the whole "cover the whole breast lying down in a radial fashion with your arm over your head " isn’t much more useful than regularly soaping down the girls in the shower without using a washcloth.

18

And you shouldn’t do it more than once a month, so you’ll more readily recognize a change.

19

My mom had a lump detected via mammogram followed by a needle biopsy and eventually a lumpectomy due to the presence of pre-cancerous cells. At the end of the day it cost our family a fuzz over $5,000 out of pocket - I’m sure insurance covered some, I just know what it cost us.

So, she didn’t have cancer and it cost us $5,000 not to mention her nervousness and discomfort. I think it was money well spent. My mom is 46 now and the lumpectomy was ~3yrs ago. I’m really glad she didn’t wait until 50 years of age to get a mammogram.

The only cancer on Ma’s side of the family that I know of was my grandmother’s leukemia. I’m not sure if Mom would have been considered “high risk” or not. In any case, I’m glad she was treated early. I don’t understand why anyone would recommend delaying a simple screening that takes 10-15min to complete when it’s quite literally a matter of life and death.

20

What rubbish. Screening for breast cancer has nothing to do with treating breast cancer. If women are undergoing unnecessarily aggressive treatment regimens, that’s because oncologists are using shitty treatment guidelines.

You might as well say that testing schoolchildren on material they’re supposed to know is dangerous because you might find out that they don’t know anything.