Doctors Stress Mammograms At 40

Siding with status quo Local doctors stress mammograms at 40 |
11/19/2009
Amarillo Globe-News - Online

Some leading Amarillo physicians are criticizing a change in breast cancer screening recommendations for women younger that 50 issued by a government task force this week.

The task force changed its guidelines on mammograms, recommending against routine breast cancer screenings for women 40 to 49 - a break from the American Cancer Society's long-standing position.

The U.S. Preventive Services Task Force, a government panel of doctors and scientists, said mammograms should start at age 50 and only take place every two years.

"Now, this is going to discourage woman from having mammograms, and that's a problem," said Dr. Rakhshanda Layeequr Rahman, an associate professor in the Division of Surgical Oncology and director of breast health at the Texas Tech University School of Medicine. "From a psychological standpoint, when you relax the standards further, it's more likely to hurt rather than help."

Nearly every breast cancer advocacy and physician group recommends screenings start at age 40.

"We as breast specialists ... recommend annual mammography at age 40," Rahman said. "We know mammography saves lives and decreases cancer mortality."

The task force also said evidence is inconclusive to recommend for or against mammograms for women 75 and older. The panel said breast self-exams do no good and women shouldn't be taught to perform them.

For about two decades, the American Cancer Society has recommended annual mammograms beginning at 40, and it reiterated that position Monday. "This is one screening test I recommend unequivocally and would recommend to any woman 40 and over," said Dr. Otis Brawley, the society's chief medical officer.

But the task force concluded that such early and frequent screenings often lead to false alarms and unneeded biopsies, without substantially improving women's odds of survival.

Doctors have learned that some cancers might develop and spread over a long period of time but never become life threatening. Other cancers are quick to spread and turn deadly.

Screening tests can miss these fastest-growing, most- harmful cancers. Until they can better distinguish between the two, cancer doctors aim to identify all cancers and treat the worst-case scenarios.

The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years. That compares with one death for every 1,339 women age 50 to 74, and one death for every 377 women age 60 to 69.

"It almost seems like a step backward," said Dr. Marjorie Jenkins, executive director of the Laura W. Bush Institute for Women's Health.

Jenkins echoed the thoughts of others and said the task force recommendation might lead insurance companies to not cover mammograms for women younger than 50 because they aren't recommended.

Without insurance coverage, a mammogram costs $100 to $120, Jenkins said.

As a clinician, she advises women of the risks and uncertainties of mammograms, such as false positives and redundant tests. But though she still said women younger than 50 should consider a mammogram, she also acknowledged that the data on the screenings' benefits are not clear.

"For now, I don't think clinicians will change," said Jenkins, a 42-year-old whose mother died of breast cancer at age 50.

Dr. Gary Aragon, radiologist with High Plains Radiological Associates and medical director of the Harrington Breast Center, received the news with mixed feelings. He said the recommended change this week comes with no new information.

"It's not like a new study has come out," said Aragon, adding that he tends to agree with the cancer society's age 40 start date. "Until something definitive comes out, I don't see why we should change. ... I think you are going to hurt some women who are going to benefit from early mammography."