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Support for Screening

Some local doctors do not agree with new mammogram recommendations

November 22, 2009
By RODNEY MINOR, The Leader-Herald

Getting a mammogram can be a stressful experience for many women. A government task force recently added some confusion to go with the stress by recommending most women in their 40s to not have mammograms at all.

However, local doctors The Leader-Herald spoke to last week did not agree with the task force's recommendations, and supported sticking with the American Cancer Society's long-standing position that women get annual mammograms beginning at 40.

Dr. Peter E. Dowling, chief of staff at Nathan Littauer Hospital & Nursing Home, said Thursday the task force's recommendations had already caused some confusion. Some female patients thought the guidelines for mammograms had changed, he said, when they definitely had not.

"[The task force's recommendations] are not a good idea, in my opinion," he said.

On Nov. 16, The U.S. Preventive Services Task Force, a government panel of doctors and scientists, said most women don't need mammograms in their 40s and should get one every two years starting at 50 - a break with the American Cancer Society's long-standing position. The panel 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,'' Dr. Diana Petitti, vice chair of the panel, said.

For some doctors, the false alarms may be a case of "better safe than sorry."

Dr. Tariq Gill, chairman of Medical Imaging at St. Mary's Hospital in Amsterdam, said breast cancer tends to be very aggressive in women under the age of 50. What the task force considers unnecessary surgery, he said, may be the result of doctors and a patient being uncomfortable "just keeping an eye on things."

Gill said all of the hospital's recommendations will still follow the ACS guidelines.

"[The guidelines] have done their job for the last couple of decades," he said.

The biggest shock, for Gill, was the panel also said breast self-exams do no good, and women shouldn't be taught to do them.

He noted the ACS and physicians spent years trying to get women to routinely do breast self-exams. It can be difficult to spot breast cancer, and a woman's knowledge of her own body can play a crucial role in identifying what could be a tumor.

"It's not like spotting zebras. It's an elusive disease," he said.

Better screening is reducing the number of breast cancer deaths as well, Dr. Sunjay Verma said.

Verma, the chairman of radiology at Nathan Littauer Hospital & Nursing Home, said because of the task force's recommendations it is possible fewer mammograms will come his way. That is unfortunate, he said, because if breast cancer is correctly diagnosed early, it is more easily treated.

"This, sort of, adds a layer of confusion to the issue," Verma said.

On Wednesday, Health and Human Services Secretary Kathleen Sebelius tried to ease the furor that has erupted since the panel issued its recommendations Nov. 16. She said the task force does ''not set federal policy and they don't determine what services are covered by the federal government.'' She advised women to ''keep doing what you've been doing for years - talk to your doctor about your individual history, ask questions, and make the decision that is right for you.''

There has been speculation in the media that the task force's recommendations are tied to the federal government's proposed health care legislation, as a way to reduce costs.

Dr. Timothy Wilt, a member of the U.S. Preventive Services Task Force, denied accusations that the recommendations were made to help the government spend less on mammograms.

''Costs are not considered at all,'' he said.

Dowling said if reducing costs is the issue, reducing the number of mammograms is not the way to go about it.

The best thing every woman could do that would impact health costs would be reducing any smoking they do, and increase their level of fitness. Those are two things guaranteed to decrease their chances of developing cancer, he said.

Beyond that, he said, women should talk to their doctor about their individual history and make the decision that is right for them.

Gill said there has always been an element of cost taken into account. A physician has to take the cost into consideration before doing these tests, he said.

Gill said he did not know how the recommendations would affect insurance companies. If insurance companies stop paying for mammograms for women in their 40s, he said, it is possible more clinics will have to be provided for women to meet the ACS guidelines.

Wilt said the panel's recommendations ''were based on the most rigorous peer review of up-to-date, accurate information about the evidence about the harms and benefits of treatment."

The ACS continues to recommend women follow its guidelines.

"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.

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 Nov. 16.

''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.

On Wednesday,?U.S. Sen.?Kristen Gillibrand requested the federal government clarify the new recommendations for women on how to prevent breast cancer.

In a letter to Sebelius, Gillibrand noted the confusion generated by the nationwide disagreements among doctors.

"I, therefore, implore you to work with these respected patient advocacy groups, radiologists and oncologists across the nation to come up with a clear message to women about how best to protect themselves," Gillibrand wrote in her letter to Sebelius.

Information from the Associated Press was used in this story.



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