Deborah Breiter almost cried when she read that an expert panel had recommended most women should not start receiving mammograms before age 50.
After all, it was an early mammogram that detected the 44-year-old Rockford College chemistry and biochemistry professor’s breast cancer just months after she had worked on breast cancer research during a 2006 sabbatical.
“It was just these few tiny microcalcifications that my doctor found. You could only see them on a magnified mammogram,” said Breiter, who 18 months out from completing her treatment still chokes up when discussing her diagnosis. “I had no particular risk factors, no family history, no lumps, nothing to suggest that I could, at all, be at risk.
“My first reaction, when I saw that recommendation, was ‘If I had waited until I was 50, would I even be alive today?’"
In a departure from past recommendations on breast cancer screening, the U.S. Preventive Services Task Force said Monday that most women in their 40s don’t need mammograms — X-rays of the breast that can detect signs of cancer that cannot be felt — and that women should get one every two years beginning at age 50. The task force, an influential panel of doctors and scientists that provides preventive care guidelines for doctors, also said breast self-exams do no good, and women shouldn’t be taught to do them.
Adverse reaction to the new recommendations came almost immediately from the American Cancer Society, which has long recommended annual mammograms beginning at age 40.
Other groups, such as the American College of Radiology and the American College of Obstetrics and Gynecology, weighed in against the new recommendations.
More emotional reactions came from women, like Breiter, whose cancers were detected by early screenings and from others whose lives were upended by breast cancer.
And two days after the new recommendations were issued, U.S. Health and Human Services Secretary Kathleen Sebelius entered the debate, saying women should continue getting regular mammograms starting at age 40.
But Dr. Martin Lipsky, dean of the University of Illinois College of Medicine at Rockford, said the task force did exactly what it was charged with doing by weighing the risks and cost effectiveness of the screening for younger women in whom breast tissue is denser, making mammograms harder to read and often leading to additional mammograms or biopsies to determine if cancer is present.
“The task force works strictly on data,” Lipsky said. “They really look very hard at the evidence, but what it comes down to is that these are recommendations for a population and not for individuals. They are not intended to apply, for instance, to somebody with a family history of breast cancer.
“Part of the concern is that, theoretically, there is a risk to mammography. If you do thousands of mammograms to save one more life, there is a theoretical risk that that’s enough radiation that among those thousands you may induce a breast cancer, so it’s tricky and not a straightforward argument.
“If a patient comes in and says they want one, well, what am I as a doctor going to do? The physician still has to sit down and determine how it applies to their patient and then discuss with them what the patient wants.”
Dr. Kent Hoskins, head of the breast cancer risk evaluation program at OSF Saint Anthony Medical Center and of the high-risk breast cancer program at University of Illinois College of Medicine in Chicago, said there has been a 25 percent reduction in deaths from breast cancer since 1990.
About half of the reduction, he said, is attributable to mammograms and the other half to continuing improvements in treatment.
He said the task force, which last made a recommendation on breast cancer screening in 2002, does a meta-analysis of several randomized trials and pools the results as part of its work.
“What they concluded in 2002 was that, in the 40-49 age group, there was a 15 percent reduction in breast cancer mortality in groups that got the screening as opposed to groups that didn’t.”
A study completed after 2002 in the United Kingdom studied the effectiveness of screenings specifically in the 40-49 age group came up with the same 15 percent reduction.
“We, here, have not changed our practice,” Hoskins said. “Our feeling is that it reduces the risk of mortality in women ages 40 though 49 and we still recommend annual mammograms starting at age 40.”
Dr. Phillip Higgins, an obstetrician and gynecologist with Rockford Health Physicians, said, “I think what they’re really recommending is to take this information and discuss it with your physician. When we suggest a mammogram, it’s to find out which of our patients will be at risk for breast cancer as well as which will benefit from early diagnosis.”
He said 70 percent to 90 percent of the women his practice finds with breast cancer showed no particular risk factors before the mammogram and nothing was found in breast examination.
“The American College of Obstetrics and Gynecology is not changing its recommendations,” he said, “so what I’m telling my patients is that, based on the body of information, they should be having a mammogram every year from age 40 on.”
Dr. Frank Bonelli, a radiologist with SwedishAmerican Health System, said he also is adhering to the former screening guidelines and said, “My personal feeling is that we should be doing mammography at age 30 or 35.”
He said the health system’s records show that 6 percent of its breast cancer patients are younger than 40 and an additional 17 percent are between 40 and 49. He also said SwedishAmerican’s radiologists have had several patients “who came in because they did a self-breast exam and they felt a cancer.”
Bonelli said he understands the task force’s concern that having to undergo a second diagnostic mammogram or a biopsy could cause anxiety in a patient and said SwedishAmerican tries to ease that with same-day diagnostics of mammograms.
“When it comes to cancers, size matters,” Bonelli said. “If these younger women delayed their screening until later, they come to us with more advanced cancers. If they come to us when the cancer is small, we may be able to treat with radiotherapy, possibly avoiding chemotherapy and avoiding mastectomy.”
Higgins said he hopes the task force revises its recommendation because he is concerned that insurance companies might seize on it to refuse to pay for mammograms in women under age 50 without demonstrated risk factors.
“I think you could see the possibility that there would be fewer screenings if the patient has to pay for them out of pocket,” Higgins said. “That could lead to reduced detection and patients coming to us later with more advanced cancer.”
Reach staff writer Mike DeDoncker at firstname.lastname@example.org or 815-987-1382.