People worried, confused by new mammogram recommendations

Wednesday, November 18, 2009 | 12:01 a.m. CST; updated 9:27 a.m. CST, Thursday, November 19, 2009

COLUMBIA — Women are responding to the new recommendations on mammograms with worry and confusion.

Tuesday at Ellis Fischel Cancer Center, Paul Dale, a surgical oncologist, said he was already receiving phone calls from his patients.

"Just this morning, I had several women in their 40s call and cancel their mammograms," he said. "They asked, 'Why should I take this unnecessary test?'"

Matt Splett, a spokesman for MU Health Care, said the cancer center hasn't taken an official stance on the new recommendations.

The U.S. Preventive Service Task Force has changed its recommendations for breast cancer screening. The task force now says that women should begin regular mammograms at age 50 — instead of 40 —and that they should get them every two years, instead of annually. The guidelines also recommend that women stop performing self-examinations.

Dale said he's unhappy with the recommendations. He said the benefits of mammography outweigh the potential risks. He cited a steady decline in the death rate of breast cancer, attributing it to early detection, in part because of mammograms.

"I've never once had a patient diagnosed with cancer leave saying, 'Wow, I wish I hadn't had that mammogram because it hurt,'" he said. "They always leave saying, 'My life might have just been saved.'"

The new guidelines are meant to lower the potential harm associated with mammograms and do not apply to women who have a high-risk of breast cancer. These harms include false positives, unnecessary biopsies and increased stress about cancer.

"It's important to understand that we are not recommending that women don't get mammograms," said David Grossman, a member of the task force and a professor of health services at the University of Washington. "We think it should be a woman's choice."

Grossman stressed that the task force recommends that when women reach their 40s, they talk to their doctor about family health history, other risk factors and their general fears and anxiety about cancer before deciding to undergo a mammogram.

"Mammograms make great sense to women in their 60s," he said. "But the risk of breast cancer is much higher for someone in her 60s."

It's unclear what percentage of breast cancer cases are diagnosed in women under the age of 40. Overall, the risk is low and increases with age.

For women in their 40s, there is a small net benefit, Grossman said, but it's small because there are substantial harms.

"I think it's a travesty," said Michael Richards, a radiologist at University Hospital. "I think it's an attempt to take women in their 40s and throw them under the bus." 

Doctors are still learning about breast cancer, he continued. But what they do know is that women in their 30s and 40s tend to present with more aggressive forms of cancer than women in their 60s or 70s. So if the cancer isn't caught early, the survival rate is very low.

Richards said he had not received any calls from female patients about the new guidelines, nor had he heard about appointments being canceled.

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