When the new guidelines from the United States Preventive Services Task Force were announced this past Monday, there were many women, patients and physicians alike, who were upset and outraged about the advice to not start mammograms until the age of 50, and in addition, a woman could have her mammograms done every other year instead of every year. The task force cited studies and data that showed a low death rate from breast cancer in the age 40 to 49 group. It also discussed the harms that many women go through during their annual mammograms. These include more testing and more biopsies, which may be considered unnecessary. These tests and biopsies also contribute to great anxiety and stress for women. Given this information, the members concluded that mammograms were being performed too often, and as a result, they were causing risks which outweighed the benefits of mammograms.
We in the breast cancer community have made great strides with breast cancer awareness, reminding women to have their mammograms yearly and to have clinical breast exams yearly along with self-breast exams monthly. These recommendations have come about because of decades of research which have shown that early detection is the key to surviving breast cancer. When breast cancer is contained in the breast and has not spread outside to the lymph nodes or to other parts of the body, the survival rates are greater and can exceed 95% in 5 years. If breast cancer has spread to the lymph nodes or to the bones, liver, lungs, brain, etc., then this number drops significantly. In addition, we also know that women who are premenopausal have a greater chance of developing more aggressive tumors since they are still having their cycles. This means that they are more likely to die from breast cancer if they are diagnosed under the age of 50. The death rates are less in women in their 40’s but these new guidelines may translate into women having more aggressive breast cancers, and subsequently dying from them. Is it acceptable to see more women dying from breast cancer? The answer should be no. We have to be proactive and fight breast cancer as aggressively as possible. We cannot take steps backwards and allow more women to have debilitating disease or deaths.
Mammograms are good tests to detect breast cancer but they are not perfect tests. We know that they have a 15% false negative rate for breast cancer detection but they are the best tests we have right now. The statistics show that 1 in 2 women who are eligible to receive a mammogram actually get one. This is a 50% user rate. Many women who have no family history believe that they won’t get breast cancer, but the stats show otherwise. For all women who are diagnosed with breast cancer, 70% of them had no risk factors. I fear that these recommendations will cause women to believe that they do not need their mammograms every year and that they can wait until two years to have them done. We have seen mammograms change in a 1 year period and early detection is best achieved by having regular annual mammograms. They can detect microcalcifications, which can be the earliest sign of breast cancer.
I am very concerned that all of the advances that have been made in breast cancer will change and reverse course in the next few years. This is not the direction that we want to go. Women need to stand up for themselves and not allow intermittent health care to become the new standard. We don’t want to see our family members, friends and loved ones having more advanced breast tumors and possibly more deaths. Many groups such as the American Cancer Society share these thoughts, and have come out with statements that they are not changing the previous guidelines. These recommendations are:
- Start annual mammograms at age 40.
- Have a clinical breast exam one a year.
- Perform self-exams monthly if you are comfortable doing so.
- If you have family history or other risk factors, you may need to start mammograms earlier, so discuss this with your doctor.
Lastly, my patients have asked me if the guidelines are representative of things to come in health care. The Health and Human Services Secretary did state that the USPSTF does not set policy, and I hope that this is true. I don’t know if these guidelines will be adopted and result in insurance companies not covering mammograms in the future, but I can say that if this were to occur, that women should contact their congressmen and senators to oppose these cuts. This is not a political blog, so therefore, I will end the discussion there but I leave you with one last thought: We women need to take care of ourselves, so that we can take care of our loved ones around us.
I will not have a post for the following week because of the holiday. I wish all of you a Happy Thanksgiving!
Katherine Lee, MD