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Guidelines might not affect behavior

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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.

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Some Augusta doctors still stand behind early detection methods.  Rainier Ehrhardt/Staff
Rainier Ehrhardt/Staff
Some Augusta doctors still stand behind early detection methods.

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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justus4
101
Points
justus4 11/18/09 - 03:06 am
0
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The U.S. Preventive Service
Unpublished

The U.S. Preventive Service Task Force must get new leadership - and soon! This directive is so convoluted and confusing that its effect will be more harm than good. The agency should close shop and go home, because printing such a reckless report does nothing to advance women's health. These recommendations should be ignored by all women.

NEone
6
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NEone 11/18/09 - 05:17 am
0
0
This directive allows the

This directive allows the insurance companies to change their standards and will save them money. That's the bottom line.

struggling parent
1
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struggling parent 11/18/09 - 07:16 am
0
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Yes ignore their

Yes ignore their recommendations. I've known people younger than 50 fighting cancers, that was caught due to mammo. I was 35 for baseline and screened every other year starting at 40 till one turn 45.. I was 42 when I complained of pain in my right breast and had mammo. Thank goodness it was benign. If I had to wait until 50, what it would be by then..I had one friend who had mastectomy and gone through chemo. She is not even close to 50 years of age. They need to start earlier, not later.

treerock
0
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treerock 11/18/09 - 07:43 am
0
0
just get plenty of vitamin d

just get plenty of vitamin d from the sun, about 30 minutes per day, a little longer if your skin is darker. and eat a proper diet of actual food instead of processed poison. look at the ingredients list on the label, if it has stuff you cannot pronounce, it is not food and your body will not use it to nourish itself. health care reform needs to start with some personal responsibility, but this is america and homer simpson said it best: "can't someone else do it?"

TechLover
15
Points
TechLover 11/18/09 - 08:13 am
0
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" it calls for individualized

" 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." Unfortunately mammograms tend to have a high false positive rate. NEJM-"With a median of four mammograms per woman, 23.8 percent had at least one false-positive mammogram over the 10-year period.With a median of five clinical breast examinations per woman, 13.4 percent had at least one false-positive.A total of 31.7 percent had at least one false-positive result for either test...The investigators believe the study may, in fact, underestimate the false-positive rate for mammography in the United States".It makes since to have it individualized.If you are at high risk, family history, etc, it would probably be better to start earlier and have them more frequently. With over 30% false postives, many women are subjected to fear, anxiety, and costs of additional tests unnecessarily.Hopefully better diagnostic methods will come about. 3-D mammography appears to have potential. With hospitals pouring millions into womens' centers, the debate will continue between them and insurers over the best course.

sgachief
0
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sgachief 11/18/09 - 08:21 am
0
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contrary to what the liberal

contrary to what the liberal media want you to hear this is just a water testing for bigger things to come when Obamacare becomes law. a dead patient is no longer a liablity to ins. cos. or the govt.

TechLover
15
Points
TechLover 11/18/09 - 08:39 am
0
0
I think I'll go buy some

I think I'll go buy some stock in Alcoa. The tin foil hat crowd appears to be growing. Buy a bunch chief, you need it.

mercyme
0
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mercyme 11/18/09 - 08:58 am
0
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This is all for insurance

This is all for insurance purposes. I was 42 when I found my breast cancer. I had had sonograms and mammograms since I was 32 years old, but found it through self screening. People need to be aware that breast cancer can happen to anyone at any age. It happens all the time. It is very important to get early mammograms and to teach early self screening. Please don't let the government tell us how to take care of ourselves. We are important and need to take care of ourselves. Knowledge about this is very important.

mercyme
0
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mercyme 11/18/09 - 09:06 am
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By the way, I forgot to add I

By the way, I forgot to add I am a 13 year breast cancer survivor. If I had not found it myself I would not be here. The mammograms had not picked the tumor up just 3 months before and the doctors said it was probably just a milk duct that was inflamed. Trust your God given intuition and have it checked out by a good doctor or several doctors until you find out for sure, don't let them brush you off with answers that don't satisfy your questions.

TechLover
15
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TechLover 11/18/09 - 09:09 am
0
0
mercy; The trick is you found

mercy; The trick is you found yours with self screening. That was cause for testing. Why the heck the ACS has been " backing off promoting them in recent years." I don't know. There is evidently disagreement among some professional organizations over guidelines and recommendations. The government is not telling you how to take care of yourself.

ispy4u
0
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ispy4u 11/18/09 - 09:22 am
0
0
Did you blame Bush, when they

Did you blame Bush, when they issued the same recommendations in 2007? @ SGACHIEF. Some idiots just cannot pass up a chance to criticize OUR President.

APiratesLife4Me
0
Points
APiratesLife4Me 11/18/09 - 10:02 am
0
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I wonder if Michelle obama is

I wonder if Michelle obama is going to wait until she is 50 to get a check up? Heck no...... What a moron she has for a husband.

DMC
0
Points
DMC 11/18/09 - 10:03 am
0
0
I think that this is a load

I think that this is a load of junk. I am a breast cancer survivor. I had it at the age of 26. I did not find the cancer because of a mammogram, but it helps in catching cancer in those that do get them every year. There are plenty of people that have had breast cancer before the age of 50. I have noticed that the cancer that was hitting the older generation is now hitting the younger generation more and more often. I think that the ones that have come up with this recomendation are very ignorant to the real world.

YellowHammer
0
Points
YellowHammer 11/18/09 - 10:24 am
0
0
It's just a hint of what

It's just a hint of what we'll be facing when you have rationed government healthcare. Does the timing of this seem a little strange?

corgimom
32206
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corgimom 11/18/09 - 12:00 pm
0
0
What this report is saying is

What this report is saying is that mammograms are not the wonderful screening tool that we all have been taught, because they are frequently wrong, both false positive and false negative. Too many women are relying on them as the definitive test. Get them as often as you want, just be aware that they are not very good tests.

soldout
1280
Points
soldout 11/18/09 - 12:21 pm
0
0
The establishment gets upset

The establishment gets upset over any research that creates less tests or less money generated. Health is a money making business as well as a health business. Tree rock gave good advice. When the World Health Organization said health had improved over the last 200 years 90% due to sanitation and 10% to health services and even less due to vaccinations people got upset then too. Nothing wrong with doctors making money but when the health industry gets so big as it is now, money can cause them to like some research and dislike other research.

soldout
1280
Points
soldout 11/18/09 - 12:27 pm
0
0
For early cancer detection

For early cancer detection mammography has been used the 1950's. Today there is another cancer screening option. Digital infrared thermal imaging or thermography was FDA approved for use in 1982. It is a non-invasive method that is pain-free and radiation free. Thermography is a quick and easy procedure using an infrared camera to detect abnormal skin temperatures, which can be an indication of tissue inflammation. Thermography often indicates potential problem areas in tissue up to 10 years earlier than a mammogram. Where mammography is looking for actual masses, thermography is a test of physiology and looks for functional changes in the breast tissue which may indicate problems before the mass forms. In a German study using computerized regulation thermography, the accuracy of diagnosis rose to 92%; 20% more accurate than mammography.

soldout
1280
Points
soldout 11/18/09 - 12:38 pm
0
0
I assume thermography is

I assume thermography is available here but is also in Wagener at www.ajounreytohealth.net if someone has an interest.

mable8
2
Points
mable8 11/18/09 - 02:07 pm
0
0
Mammograms are not accurate;

Mammograms are not accurate; as a matter of fact, the failure rate in detecting breast cancer is rather high. I think it is the most over-rated exam used and it is also one of the more costly exams.

dont live there anymore
2
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dont live there anymore 11/18/09 - 04:04 pm
0
0
soldout. Read my comment on

soldout. Read my comment on another thread. I am a survivor of ten years. By the way my wonderful and competent physicians were in Augusta. mable8, no test is 100% accurate but many lives are saved by mammograms. The problem is that people do not have them done because they are told how much pain there is. Then when found the tumor has progressed. I can tell you there is pain but only momentarily and much of the discomfort (or comfort) depends on the technologist. Early detection is extremely important and may preclude use of chemo or radiation. GET A MAMMOGRAM!

dont live there anymore
2
Points
dont live there anymore 11/18/09 - 04:07 pm
0
0
justus4. The best comment

justus4. The best comment you have made in months. I agree with it.

mercyme
0
Points
mercyme 11/18/09 - 04:23 pm
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Techlover I should have left

Techlover I should have left that last part about the government telling us how to take care of ourselves. Sorry it bothered you!!!! There is always one in the crowd!!!

JohnQPublic
5
Points
JohnQPublic 11/18/09 - 11:54 pm
0
0
Bump them! I'll keep doing my

Bump them! I'll keep doing my yearly! It's my body and I will do what I have to do for me. Why is everyone so easily stirred by the bs? No one can make you NOT do anything. It's another bunch of bull to get your focus off of the topic which is the health care companies ripping us off! This is only the opinion of a few who are probably getting paid by a health care corporation to scare us. Ignore them. By Jane Q. Public

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