Guidelines might not affect behavior

Augusta physicians and breast cancer patients roundly rejected Tuesday a government panel's recommendation that women wait until age 50 to begin mammogram screening, and then only every other year.

At a breast cancer conference Tuesday morning at University Hospital "everybody was kind of miffed by it," said radiologist Marion Wier, a co-director of University's Breast Health Center. Still, with prominent breast cancer groups such as the American Cancer Society and others recommending the earlier screening, and considering the mind-set of women to get it earlier, it is unlikely things will change, Dr. Wier said.

The U.S. Preventive Services Task Force recommended Monday against annual mammogram screening in women ages 40 to 49 and biennial screening in women ages 50 to 74. In a supporting article published in the Annals of Internal Medicine , a group found that screening beginning at 40 reduced mortality only by an additional 3 percent over starting at age 50, which works out to about 1 less breast cancer death per 1,000 women. The panel found the earlier annual screening would produce about 2,250 false-positives per 1,000 women, about 7 percent of whom would be biopsied.

Some Augusta radiologists said that false-positive rate sounds too high. It should be about 5 percent, or 50 per 1,000, said Suzanne M. Thigpen, the chief of mammography at Medical College of Georgia Hospital and Clinics. The false-positives, where women are called back for more imaging or a biopsy, is an unfortunate necessity in catching a disease that can often be subtle or obscured, radiologists said.

"We create lots of anxiety in the ladies that don't have disease looking for the ones that do," Dr. Wier said.

The recommendations seem to fly in the face of the oft-repeated message about early detection through mammograms, which has greatly improved survival by catching the tumors at an earlier stage.

"I think they're making a backward step with the recommendations, and they're possibly going to cause significant harm to women's health," Dr. Thigpen said. "We have changed the outcome of breast cancer from the 1950s until now, and we have done it with screening mammograms."

That is especially true for younger patients, she said.

"The cancers that we see in younger women tend to be more aggressive," Dr. Thigpen said.

The recommendation for 50 and over screening hit home with Sherry Scott, whose breast cancer was discovered through a screening mammogram in May 2008, when she was 47 years old.

"I shudder to think where I would be in two more years if it had gone undiagnosed," said Mrs. Scott, whose battle with breast cancer was featured in October 2008 in a three-day series in The Augusta Chronicle . She urged women to start at age 40 and continue to get them annually.

"It's very, very important," Mrs. Scott said.

The government panel also recommended against teaching women breast self-examination, which really peeved Heather Doan of Ridge Spring, who discovered her breast cancer at age 39 through a self-exam in October 2008. Her mother was diagnosed with breast cancer at age 45 after she discovered it first herself.

"If it wasn't for a self-exam, myself and my mother probably would not be living," Mrs. Doan said.

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.

WIDE DIVISION IN RECOMMENDATIONS

With Monday's announcement, major medical groups remain divided in their recommendations on mammograms.

The National Cancer Institute recommends women receive mammograms annually or every other year beginning at age 40. The American College of Obstetricians and Gynecologists says the same thing but tells women to be screened annually after age 50. The American Cancer Society and the National Comprehensive Cancer Network also recommend annual screening.

The U.S. Preventive Services Task Force came out Monday against routine screening for women in their 40s; instead, it calls for individualized decision-making. The American College of Physicians, which represents internal medicine doctors across the U.S., issued similar recommendations in 2007.

The recommendations by the task force are more in line with overseas guidelines, which call for screening to start at 50; the World Health Organization recommends a test every two years. As for breast self-exams, medical groups such as the American Cancer Society have been backing off promoting them in recent years.

-- Edited from wire reports

 

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