Local doctors disagree with new mammogram finding

By Lisa Kaczke | The Daily Journal

Published 04:47 p.m., November 18, 2009

A new finding that most women don’t need mammograms in their 40s isn’t changing the minds of local oncologists.

A government task force said Monday that most women should get a mammogram every two years starting at 50 — a stunning reversal and a break with the American Cancer Society's long-standing position. What's more, the panel said breast self-exams do no good, and women shouldn't be taught to do them.

For most of the past two decades, the American Cancer Society has been recommending annual mammograms beginning at 40, and it reiterated that position on Monday. “This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over,” the society's chief medical officer, Dr. Otis Brawley, said in a statement.

Locally, doctors disagree with the new finding by the U.S. Preventive Services Task Force, a government panel of doctors and scientists.

Dr. Wade Swenson, oncologist with the Fergus Falls Medical Group, said he personally disagrees with the finding and believes Lake Region Healthcare oncologists won’t change their recommendations for mammograms.

At Fargo’s MeritCare, which also has an outreach office in Perham, oncologists won’t be changing their recommendations for mammograms, according to MeritCare spokesman Darren Huber. He added that they’ll continue to urge women to have mammograms and encourage women to talk with their personal doctor if they have questions.

“MeritCare doctors will continue to take time to weigh all data, but for now MeritCare suggests staying with the current guidelines,” Huber said.

Federal policy on who should get breast cancer screening has not changed, Health and Human Services Secretary Kathleen Sebelius said Wednesday. She issued a statement aimed at easing confusion over the government panel's recommendation.

The new finding also calls for women to discontinue having mammograms after the age of 75, but women will probably continue to receive mammograms past that age, Swenson said.

He added that he’ll also continue to recommend mammograms for women younger than 35 if they have a strong family history of breast cancer.

Swenson noted that there’s been debate for years on the age at which women should begin to get mammograms and the frequency. He pointed out that there isn’t a debate on whether mammograms reduce the rate of dying from breast cancer.

“The verdict is still out on this issue,” Huber said. “It is something MeritCare remains actively involved in discussing and researching with others around the nation. In fact, several breast health doctors from MeritCare are traveling to the Mayo Breast Update today in Rochester for meetings with other breast health medical experts, some of which will be about this very issue.”

Sebelius noted that there has been debate about the age at which routine mammograms should begin, and how often they should be given.

“The task force has presented some new evidence for consideration but our policies remain unchanged,” she said. “Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”

“My message to women is simple. Mammograms have always been an important lifesaving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you,” Sebelius said.

In the meantime, she added, it is clear that more research is needed into ways to help women prevent and fight breast cancer.

The U.S. Preventive Services 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.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.

Swenson pointed out that groups that research cancer screenings are typically in agreement on cancer screening opinions. However, the group that typically disagrees is the Preventive Services Task Force, he said.

Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years. Decades ago, the practice was so heavily promoted that organizations distributed cards to be hung in the shower demonstrating the circular motion women should use to feel for lumps.

As for mammography, the panel's new recommendations are more in line with international guidelines, which call for screening to start at age 50; the World Health Organization recommends the test every two years, and Britain says every three years.

They were sharply challenged by the cancer society on Monday.

“The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not,” Brawley wrote.

That stance “is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them,” he added.

But Dr. Amy Abernethy of the Duke Comprehensive Cancer Center agreed with the task force's changes.

“Overall, I think it really took courage for them to do this,” she said. “It does ask us as doctors to change what we do and how we communicate with patients. That's no small undertaking.”

The Associated Press contributed to this report.

---

WOULD YOU LIKE TO SHARE THIS STORY?

---