LEWISTOWN - Local breast cancer specialists and advocacy groups are voicing their opinions about new guidelines for breast cancer screening set by the U.S. Preventive Services Task Force.
According to the U.S. Department of Health and Human Service Web site, the USPSTF recommends against routine screening mammography in women aged 40 to 49 years.
"The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms," the site states.
Other recommendations include, according to the site, biennial screening mammography for women aged 50 to 74 years and a position against teaching breast self-examination.
According to the site, three potential screening harms associated with mammograms were examined as part of the study, "Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms." They are: false-positive mammograms, unnecessary biopsies and overdiagnosis.
According to the study, more than 190,000 women in the United States will develop invasive breast cancer in 2009, and more than 40,000 of them will die of the disease. Reductions in breast cancer mortality is associated with screening from ages 50 to 74 years, the study states, but trial results for women age 40 to 49 and women age 74 or older were not conclusive. The study states it is not feasible to conduct additional trials to get more precise estimates of the benefits outside the 50-to-74 age group.
Local specialists' opinions
Dr. Cathleen M. Veach, medical director at Family Health Associates, said the new guidelines are not consistent with the American Cancer Society's recommendations.
"As a primary care provider and female physician, I was shocked by this drastic change in preventive guidelines by the USPSTF," Veach said. "Until there is strong and convincing evidence that the benefits of mammograms in women in their (40s) do not outweigh the risks, I am going to continue to recommend starting at 40."
Dr. Jim Evans, director of breast surgery at Geisinger Health System in Danville, said it would be helpful for people to understand that a lot of the concern surrounding the new guidelines is based on emotion. It is not uncommon for preventative guidelines to change, he said, since research groups are always getting new information.
"This is not a new issue that we're talking about," he said.
Evans said decisions regarding mammograms should come down to a discussion between the patient and the physician, and individual consequences should be evaluated, he said.
"I think that will continue to be the case," he said.
The USPSTF spends a lot of time reviewing data and does credible work, Evans said, and recommendations as well as prevention and treatment is based on scientific evidence.
Evans said Geisinger has not released an official statement in light of the new guidelines regarding any policy change on mammogram screening.
He said Geisinger's breast service group will review USPSTF data and "adjust our policies accordingly."
The breast service group, comprised of surgeons, breast radiologists, radiation oncologists and other specialists, come up with plans that are logical for Geisinger, Evans said.
Dr. Ricardo Carter, medical director at Lewistown Hospital's cancer program, said the new guidelines move breast cancer diagnosis, treatment and outcome backward.
Seven years ago the USPSTF recommended that women begin getting routine mammograms and doing self breast exams starting at age 40. The new guidelines, he said, are contrary to the old recommendations.
The new guidelines, Carter said, have the potential to cause women a "tremendous" amount of anxiety because they might feel confused about what to do now, in terms of breast cancer screening.
He added that the new recommendations are not endorsed by the American Cancer Society and other such organizations.
"I don't think we should change what we're doing," he said.
Carter said different recommendations constantly are coming out and people have to be careful about how they respond. Guidelines such as these should be carefully looked at and discussed, he said.
"I think it would be a disservice to all women if the guidelines are adopted," he said.
Carter said yearly mammograms reduce the death rate from breast cancer by 15 percent.
"Everyone knows mammograms (are) going to save lives," he said.
Carter said a big risk associated with the new guideline is that doctors might see more advanced cancers.
There are a lot of women under the age of 50 with breast cancer, Carter said, and in at least 80 percent of breast cancer cases, women feel their lumps first, during a self breast exam.
Carter said the best advice he can offer to women and their families is not to panic and to keep doing what they're doing.
What groups and organizations are saying
The PA Breast Cancer Coalition is concerned about the new guidelines because it knows, from existing research, that mammograms save lives, according to a statement by Pat Halpin-Murphy, president and founder of the organization.
"The USPSTF cites three potential harms of mammography: anxiety, extra procedures and costs due to false-positive results," according to the statement. "Anxiety should not have bearing on whether women ages 40 (to) 49 are screened. Compared to getting breast cancer, anxiety is a minor concern. Women would rather they don't have breast cancer."
The coalition hears daily from women that have been diagnosed during their yearly mammograms, Halpin-Murphy said, and many of those women are ages 40 to 49 without any family history of breast cancer.
"These women have been diagnosed in early stages because of these initial screenings," she said.
Otis W. Brawley, chief medical officer of the American Cancer Society, said in a statement the organization still recommends annual mammography screening and clinical breast examination for all women beginning at age 40.
"Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions," he said.
Brawley's statement points out that a 2003 study not unlike the current USPSTF review "found convincing evidence that screening with mammography reduces breast cancer mortality in women ages 40 (to) 74, with age-specific benefits varying depending on the results of individual trials and which trials were combined in meta-analyses."
Like the USPSTF, the American Cancer Society panel also found that mammography has limitations. Some women who are screened will have false alarms, some cancers will be missed and some women will undergo unnecessary treatment, Brawley noted. The limitations decrease with age, he said, "but the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives.
"As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: this is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member," he said
Angela Kerstetter, survivor liaison of Central Pennsylvania Pink Connection, a breast cancer support group that serves those affected by breast cancer, said as a breast cancer survivor, age 50 is too old to begin getting routine mammograms. Women should start getting routine mammograms between ages 30 and 35, she said.
"I was diagnosed at 29," she said.
At the time of her diagnosis, her doctor told her she had breast cancer for two to five years before she was actually diagnosed.
"I do carry a breast cancer gene," Kerstetter said, which makes her situation different from other cases.
She was advised by her doctor, she said, to begin mammography screening for her daughter 10 years prior to her individual age at diagnosis, Kerstetter said, meaning her daughter will begin getting mammograms at age 19.
"I'm actually very happy about that," she said.
Through her experiences at Central PA Pink Connection, Kerstetter said about seven out of 10 women served by the organization are under age 50 at the time of their diagnosis.
While Kerstetter agrees that mammograms in younger women can cause false positives due to an abundance in hormones, they are worth it.
Kerstetter said before her diagnosis she was adamant about "not taking no for an answer."
"I found a new lump that felt different from the rest," she said.
After a needle biopsy came back as nothing, Kerstetter requested a mammogram, she said.
"That's when everything showed up," she said.
She continued, "I wouldn't have known ... I truly believe, today or a year from now, I might not be here if I wouldn't have insisted on that mammogram."
Kerstetter said mammograms do cause anxiety, but "it's all worth it to know that you're fine or that something is wrong," she said.
