maven&meddler

Like a lot of women out there, I was really confused by the headlines about delaying regular mammograms until age 50, and I was somewhat appalled by the suggestion as well. I’d have addressed this sooner, but I’ve been out of town and didn’t have access to my blog.

Had I waited until age 50, I might not be sitting here telling you about it. I was diagnosed at age 49, and according to the experts at the nation’s top cancer research institute and hospital, my cancer had been there at least two years, if not longer. What am I supposed to think about starting mammograms at age 50, and then getting them only every other year?

Call me a cynic, but I think this is somehow being driven by healthcare cost containment and the insurance industry.

Let’s think this through on another level: if there are so many false positives and unnecessary biopsies, let’s take a good look at why there are so many false positives and poorly done biopsies. In other words, don’t kill the messenger!

I’ve seen this happen time after time here in Reno. A substandard mammogram, that led to excisional biopsies that led to unnecessary mastectomies that led to overall poor outcomes. Why aren’t we taking a good hard look at the whole picture here?

At M. D. Anderson, the mammograms (equipment and the well trained technicians and radiologists) are far and away superior, and then any suspicions are followed up with other techniques such as ultrasound and other imaging to confirm those suspicions. They are adept with ultrasound guided Fine Needle Aspiration type biopsies that are quick, minimally invasive and provide excellent characterization of the real existance (or not) of cancer and it’s extent. This is standard of care. This same standard of care doesn’t exist far too many areas of the country.

Is anybody asking why? No.

To simply declare that mammogram screening is unnecessary until age 50 and then only occasionally is a deceptive and potentially deadly way of addressing the wrong problem. This pisses me off.

Here’s what I was waiting to see, however, M. D. Anderson’s official position on mammography screening:

M. D. Anderson Maintains Mammogram Recommendations

By Cancerwise Blogger on November 16, 2009 4:41 PM |

If you’re a woman or a spouse or loved one of a woman —and that likely covers most people we know — you may be struggling with how to interpret some new guidelines on breast cancer screenings that were issued today by the U.S. Preventive Services Task Force. You’re probably very surprised to read their recommendations to push back initial mammograms to age 50 and conduct follow-ups every two years.

Thanks to the efforts of the American Cancer Society, Komen for the Cure, Avon, many other advocacy groups and even M. D. Anderson’s own Public Education Office, it’s likely that most women and their physicians would answer “40 years old” to the question: At what age should you get your first mammogram? Furthermore, we’d expect to hear “every year” in response to the question of how often to have this test.

Based on practices in our Cancer Prevention Center and the risk-based guidelines for breast cancer screenings, M. D. Anderson is standing by those recommendations.  

If you’re of average risk, M. D. Anderson recommends you get your first mammogram at age 40 and return every year after that for regular screenings. If you aren’t sure how to assess your risk, we recommend setting up time with your physician.

“We believe the benefits of an annual mammogram outweigh the risks for women, starting at age 40,” says Therese Bevers, M.D., professor and director of M. D. Anderson’s Cancer Prevention Center.

M. D. Anderson has studied the effectiveness of breast cancer screening and M. D. Anderson faculty contributed to the modeling analyses used by the Preventive Services Task Force to make its recommendation.   

Ongoing dialog and research on this topic are very important in the lives of many women. We’ll assess these findings and others in the annual evaluation of our guidelines in March 2010.

The task force, and M. D. Anderson, are united in our emphasis on developing risk-based,  specific breast cancer screening guidelines. We’ll continue to seek evidence that benefits women by catching this disease in its earliest stages.

“Doctors need to have more discussion about the risks and limitations of breast cancer screening with patients so they can participate in decision-making,” Bevers says. “There have been huge successes in teaching American women about the benefits of screening mammography, but women have not been educated about the limitations of screening — which is why many women believe that there is no harm in screening and if one test is good, two tests are better and more frequent testing with both is the best.”

Read more about this discussion on twitter hashtag - #mammogram40
http://tweetchat.com/room/mammogram40

Update on Wednesday, November 18, 2009 at 12:40 by mavenandmeddler

As I was unpacking bags, I listened to an all too brief (read: chopped off and certainly incomplete) discussion on NPR’s Talk of the Nation about this very topic.

It rambled on with discussions about breast self exams and blather about unnecessary anguish and expense over having to go back after a suspicious mammogram for additional imaging and perhaps biopsies …. ARRRRGGGHHH!.

Yes, having to go back for further examination is a bummer. So is dying from breast cancer.

Not until the last few seconds of the segment did anybody get around to the real issues: why aren’t mammograms better, why aren’t there higher standards of practice, why aren’t the standards the same everywhere in the country, why should standards of practice vary across the country …

They’re blaming the messenger: screening mammography.

They’re not getting to the real issues. Once again.