New Mammogram Guidelines Cause Confusion and Debate

By Barbara Ficarra, RN, BSN, MPA

Latest breaking news this week

New mammogram guidelines set by the United States Preventative Services Task Force (USPSTF) now recommends that women begin breast cancer screening every two years starting at age 50, instead of every year beginning at age 40.

These new standards sent a shock wave throughout women and the medical community.

The American College of Surgeons released a statement today on its website in strong support of the current American Cancer Society (ACS) screening mammography guidelines that recommend women get a mammogram every year, starting at age 40.

Despite the recommendations from the USPSTF, The American College of Surgeons believes the ACS guidelines have resulted in an effective approach toward dealing with the possibility of breast cancer and that women should continue to follow them in consultation with their physicians.

J. Leonard Lichtenfeld, MD, MACP, Deputy Chief Medical Officer for the national office of the American Cancer Society says in his blog “the American Cancer Society is not changing its current recommendations that women at average risk of getting breast cancer should get a mammogram every year starting at age 40.”

Secretary Sebelius addresses confusion head on

Kathleen Sebelius, Secretary U.S. Department of Health and Human Services, issued a statement on its website yesterday saying that, “There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country.”

Secretary Sebelius added, “I want to address that confusion head on. The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government.”

Radiologist disagrees with the new standards, calling them a “mistake”

“I think the United States Preventative Services Task Force new recommendations are a mistake,” says Rachel F. Brem, MD, Director of the Breast Imaging and Intervention Center at The George Washington University Hospital and a professor of Radiology.  “The only motivation of the task force recommendations can be financially driven. If implemented it would certainly cut costs at the expense of lost lives–an unacceptable trade off,” Dr. Brem said.

“Let’s not go back 20 years where more women died of breast cancer.  American women should know that they must be their own advocates, they must continue to obtain annual mammography,” she added  “and they must not allow the recommendations of the USPSTF to be implemented by insurance companies or Medicare because it will be at the expense of their lives.”

Fear Factor

According to the Agency for Healthcare Research and Quality (AHRQ) breast cancer is the second leading cause of death of women in America, and women are fearful of this horrific disease.

While women wonder what to do, (to get a mammogram or not) it’s important that they don’t let fear rule their decisions.  It’s important for women to take charge of their health and to be proactive.  They need to partner with their doctor and health care professionals.  They need to be an empowered and engaged patient, and they need to communicate with the experts to find out what’s the best option for them.

“Keep doing what you have been doing for years”

“Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years,” Secretary Sebelius said in her statement.  Keep doing what you have been doing?  Isn’t it more about being proactive and questioning decisions?  Just because something has been done a certain way for many years doesn’t mean its the most effective way to treat or prevent an illness.  If data is now interpreted differently, shouldn’t women question that?

The study is not new, says Dr. Brem

Dr. Brem says that “the USPSTF is not a new study,” and it’s important for women to realize this.  She adds,

“Rather it is merely taking many studies, which have been designed and implemented differently and performing mathematical modeling. That is nothing more than statistical machinations without direct data. The studies that directly studied the impact of mammography demonstrate up to 50% reduction in death from breast cancer.

The mortality from breast cancer in the US has decreased by 30% over the past 20 years due to screening mammography.  Every study has shown a reduction in the death rate from breast cancer due to mammographic screening. Even the report of the USPSTF reports a reduction in the death rate in all ages with mammographic screening.”

Need to evaluate mammography recommendations

A statement on the National Cancer Institute’s website posted November 16, 2009 says, “NCI has had screening mammography recommendations for many years, and we need to evaluate them in light of the Task Force’s recommendations — for all women, not only for those of average risk. It’s too early for us to make any decisions right now.”

Medical community in agreement with the new recommendations

Gabriela Cora, MD, FAPA, MBA, wellness coach, board certified psychiatrist with a Master’s in Health Administration and Policy and a Master’s in Business Administration, at the Executive Health & Wealth Institute® agrees with the new guidelines by the USPSTF.  “The decision is good from a public health perspective, particularly if tied to scientific data suggesting no benefit if started at age 40, and a tough one for the American culture looking for individual benefit “in case it happens to me” mentality,”  says Dr. Cora.  Women “will experience fear of not starting mammograms at age 40 “in case it happens to me.”  The “what ifs” kick in: “What if I have cancer and we can’t catch it on time?” Although it is true some individual cases will be missed, from a massive public health perspective, this decision may be for the ‘greater good.’”

Donald Ellsworth, M.D., physician at the Hotze Health & Wellness Center, believes that the USPSTF guidelines are correct, as the data for the benefits of mammography screening are weak and virtually absent in women under the age of 50. The Center feels that mammography screening exposes the breast tissue to potentially harmful radiation doses.

It’s apparent that controversy and debate will continue on this topic and most likely the medical community will remain divided and women will continue to be confused, wondering what is the right thing to do.  Women look for answers from experts within the medical community, but when experts remain divided, they are left confused and without answers.

Bottom Line

With any health topic it’s important to gather information, and to be proactive in your health care.  Partner with your doctor and health care professionals to discuss your options. Gather information from both sides and make an informed decision based on what is best for you.  Your doctors and health care professionals will help guide you to make the best decision for you.  I agree with Secretary Sebelius when she says, “talk to your doctor about your individual history, ask questions, and make the decision that is right for you.”

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