Mammograms

In a change of existing guidelines, an influential government panel said Monday that women do not need mammograms in their 40s and discouraged teaching breast self-exams - decisions that have sparked controversy and confusion among some breast cancer specialists and patient advocates. The U.S. Preventive Services Task Force, a government panel that issues federal recommendations on preventive medicine, said that breast cancer screening in a woman's 40s does not save many lives and can do more harm than good.

The Baltimore VA Medical Center said Wednesday it has become the first hospital in Maryland to offer three-dimensional mammograms, a technology it hopes will better detect breast cancer in women. Approved by the Food and Drug Administration last year, 3-D mammograms give a deeper view of breast tissue than traditional two-dimensional tests. The device allows doctors to examine breast tissue in individual layers rather than in one big mass. The 3-D views enable doctors to detect small lumps that may get lost in layers of tissue and thus allow earlier breast cancer detection, said Dr. Rakhi Goel, director of breast imaging at the Veterans Affairs Medical Center.

N ew recommendations about mammograms from the U.S. Preventive Services Task Force several months ago touched off confusion and debate about the breast cancer screening tool. The task force said the benefits of mammograms for most women in their 40s were small, and recommended mammograms only every two years beginning at age 50. But many doctors and patients disagreed, saying that while mammograms aren't a perfect method of detecting breast cancer, they can be lifesavers for women in their 40s. Dr. Jean Warner, director of the Tyanna O'Brien Center for Women's Imaging at Mercy Medical Center, is one of those doctors who disagreed with the recommendations.

Women are between a rock and a hard place, if you will excuse the expression, when trying to decide when, and how often, to have a screening mammogram. Start at 40? Or 50? Once a year? Every two years? Breast cancer strikes one in seven women. How do you know whether you are at risk? And when did they take breast self-exams off the to-do list? Do mammograms save lives? Or do they find tumors that would never have required treatment, putting women through the misery of surgery, chemotherapy or radiation?

Washington.--In December the National Cancer Institute revised its guidelines on mammogram screening for breast cancer. Previously, it had recommended regular mammograms for all women over age 40. Now it makes no recommendation for those between 40 and 50. Its position is that the evidence is not clear. Women, it says, should study the data and decide for themselves.This is a deeply unsatisfying recommendation, for two reasons. First, if the experts at the National Cancer Institute can't decide whether mammograms are worth while for women in their 40s, how on earth is a non-expert supposed to decide for herself?

U.S. Sen. Barbara A. Mikulski said Thursday that she will introduce an amendment to the Senate health reform bill guaranteeing women universal access to mammograms beginning at age 40. The move is a response to new recommendations from an advisory panel, the U.S. Preventive Services Task Force, which said most woman do not need mammograms until they are 50, and only every two years after that. The mammograms result in too many false positives for women ages 40 to 49 and don't save many lives, the panel said.

The Baltimore VA Medical Center said Wednesday it has become the first hospital in Maryland to offer three-dimensional mammograms, a technology it hopes will better detect breast cancer in women. Approved by the Food and Drug Administration last year, 3-D mammograms give a deeper view of breast tissue than traditional two-dimensional tests. The device allows doctors to examine breast tissue in individual layers rather than in one big mass. The 3-D views enable doctors to detect small lumps that may get lost in layers of tissue and thus allow earlier breast cancer detection, said Dr. Rakhi Goel, director of breast imaging at the Veterans Affairs Medical Center.

Q: I am 42 and have always been concerned about developing breast cancer as my mother did when she was 65. I asked my internist and gynecologist about scheduling a mammogram, and they each gave me different advice about its value. Could you resolve the conflict between the two?A: About one in eight women in this country will develop breast cancer during her lifetime, and roughly one-third of those with breast cancer will die of the disease. In women 50 years of age or older, there is universal agreement about the value of mammograms, which can detect early breast cancers before they can be felt on examination.

How many women do you know? Odds are that one in 10 o them will develop breast cancer. About one-fourth of that number will die as a result of the disease.For reasons we don't completely understand, Maryland women have a slightly higher rate of breast cancer than the national average. Two new state programs aimed at women who are underinsured or have no insurance should help prevent deaths from breast cancer.Administered through the Maryland Health Services Cost Review Commission, the "Coordinated Breast Cancer Screening Program" involves a network of 29 hospitals around the state.

In the wake of the National Cancer Institute's decision to stop recommending regular mammograms for women in their 40s, many radiologists and other doctors who treat patients continue to be convinced by their clinical experience and intuitive reasoning the benefit of routine screening for these women would be obvious if the proper studies were done.Meanwhile, women and their doctors are left in a quandary about the best use of this weapon for early detection of breast cancer, the disease women fear most.

N ew recommendations about mammograms from the U.S. Preventive Services Task Force several months ago touched off confusion and debate about the breast cancer screening tool. The task force said the benefits of mammograms for most women in their 40s were small, and recommended mammograms only every two years beginning at age 50. But many doctors and patients disagreed, saying that while mammograms aren't a perfect method of detecting breast cancer, they can be lifesavers for women in their 40s. Dr. Jean Warner, director of the Tyanna O'Brien Center for Women's Imaging at Mercy Medical Center, is one of those doctors who disagreed with the recommendations.

A Maryland House member is trying to preserve insurance coverage for early breast cancer screenings in the wake of a November report that disputed the usefulness of those tests. Del. Donna Stifler, a Harford County Republican, presented a mammogram bill last week to the House Health and Government Committee that would require insurers to follow the American Cancer Society's 2010 breast cancer guidelines. Maryland law follows ACS' most up-to-date recommendations. The bill was drafted in reaction to a report in November by the U.S. Preventive Services Task Force, in the Department of Health and Human Services, that said women only need mammograms every two years starting at age 50. The 2010 ACS guidelines call for women in their 20s and 30s to receive mammograms every three years that would be covered by their insurance, nonprofit health service plan or health maintenance organization.

We at the American College of Preventive Medicine support the updated United States Preventive Services Task Force recommendations on breast cancer screening. On Nov. 17, the task force released recommendations that women age 50 and older should have screening mammography every two years, and women in their 40s should decide whether to have screening mammography on an individual basis after talking with their doctors. Since then, misinformation and conspiratorial rumors have been rampant, including allegations that the task force is a mechanism for government or insurance industry cost-cutting at the expense of women's health.

The recommendation by the U.S. Preventive Services Task Force that mammograms not be given routinely to women under 50 and that the teaching of self-exams be de-emphasized has sparked a spirited debate among doctors, researchers, advocates and ordinary women. That's a good thing. The questions of when such screenings are most effective and what benefits and risks they provide are too seldom considered in a medical culture that tends to assume more tests are always better. There are thousands of examples of women whose potentially deadly cancers were caught early because of mammograms, and many others in which women suffered unnecessary consequences ranging from anxiety to needless treatment because the tests raised false alarms.

When a government advisory panel put out new recommendations last week that said women under age 50 need not be screened for breast cancer, the calls began flowing to Sen. Barbara A. Mikulski's office. Within days, the Maryland senator had responded with an amendment to the Senate's pending health care reform bill that would guarantee access to mammograms at age 40 through public insurance exchanges. With the health legislation as the backdrop, politicians in Maryland and across the country have reacted swiftly to the breast cancer lobby - a group that has made early screening a mantra and pink ribbons a powerful symbol in fighting the most commonly diagnosed cancer in women.

This summer, a Canadian study of nearly 7,000 women came to a startling conclusion: that a mammogram done during the second half of the menstrual cycle is twice as likely to miss a lurking cancer as one taken during the first half.For now, these researchers think this applies only to women who use or have used hormones such as birth control pills. And because there is so little research on the question, the finding could turn out to be a statistical fluke.Still, the idea is intriguing -- as is the suggestion from a handful of other studies that there may also be an optimal time in the cycle for a woman to have breast cancer surgery.

Researchers who conducted one of the world's largest studies of mammograms said yesterday there was no truth to reports, circulating at medical conferences and among oncologists, that the results concluded women under 50 were more likely to die of breast cancer after they receive the tests.Data from the study have not yet been published, but preliminary results from the large Canadian study suggest that women between the ages of 40 and 49 do not benefit from routine mammograms."We have been telling people for two years that there is as yet no benefit observed for women in this age group," said Dr. Cornelia Baines, deputy director of the Canadian National Breast Screening Study.