By Kasey Fowler, Staff Writer
The medical community is in an uproar about newly released guidelines from U.S. Preventive Services Task Force regarding mammograms for women under age 50 and breast self-exams.
USPSTF released new guidelines Monday stating a woman should wait until age 50 to get routine mammograms, because according to a study, doing so at age 40 presents potential harm. The panel also said breast self- exams do no good and women shouldn’t be taught to do them.
According to a statement released by the Dr. Otis W. Brawley, chief medical officer, American Cancer Society, ACS will stand by its long-standing recommendation for annual screenings starting at age 40.
“The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40,” Brawley said. “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.”
Local radiologists, Alicia Vanhooser, M.D., St. Mary’s Regional Medical Center’s Women’s Health and Imaging Center; and Larry Ramseyer, M.D., chair of radiology, Integris Bass Baptist Health Center, agree with American Cancer Society and will continue to recommend patients under 50 get regular mammograms.
“I would say continue having your screening annually starting at 40 until the American Cancer Society and American College of Radi-ology say otherwise,” Van-hooser said. “If a woman finds something, come in and get it evaluated. Anything palpable should be evaluated. Don’t talk yourself out of it.”
Vanhooser and Ramseyer also recommend continuing self-exams.
“I think women should continue to self-breast exam. There are still cancers detected by women themselves,” Ram-seyer said. “We see it enough, lumps that women feel that need to be evaluated. It is sort of like, what is the alternative, if you feel a lump and just disregard it? It is a three-prong approach: self-exam, a mammography and an exam by a physician.”
Vanhooser fears the new study may give women an excuse to not get their annual exam or ignore early warnings.
“The thing that concerns me the most, is they are telling women to not do self-exams,” she said. “I’m afraid it will give women the excuse if they do find something in their breast to say, ‘I just had a mammogram that was clear so I don’t need to get it checked out.’ A lot of patients find their disease on their own. You will know your breasts much better than your doctor who sees you once a year.”
Both doctors said they have seen several cases of women in their 40s with breast cancer.
“We see a lot of breast cancer in women in their 40s. For this organization to come out and say, ‘Don’t bother checking, don’t bother looking,’ is doing a real disservice to these women,” Ramseyer said. “I was looking at their information they have, and they have one in 69 women in that age group will have breast cancer. To say, ‘Let’s not bother,’ is a mistake.”
This issue hits home for Ramseyer; he said he has two sisters-in-law who were diagnosed with breast cancer in their 40s.
“I see a lot of breast cancer in 40-year-olds. It would make sense if they said we won’t screen 20-year-olds,” Van-hooser said. “No two breast cancers act alike, and we find in the younger patients it tends to be more aggressive and that is the patient I want to find.”
Vanhooser said many cases came to mind of women with breast cancer in their 40s.
“As I’m driving to work after hearing the news, all I could think of was women who were under 50 who have been diagnosed with breast cancer,” she said. “Breast cancer in women under 50 is not unusual. I had a woman who was 43 who had breast cancer in her right breast. It wasn’t palpable. I couldn’t imagine waiting seven more years to screen her. It saved her life.”
Two of the reasons the study gave for women to refrain from getting mammograms in their 40s is the extra exposure to radiation and false positives.
“One of the concerns they have is over the false positives, and we recommend further work-ups,” Ramseyer said. “A lot of times it is an ultrasound or additional mammogram. A lot of times when we call people back we can say it is clear, but if it is not we do a biopsy.
“The biopsy has gotten a lot easier in the last 15 years. We do almost all of our biopsies with a needle. The amount of radiation from the mammography is minimal. It is kind of like saying you don’t want to move to Denver because they have more exposure to radiation from the environmental radiation. It is not a concern.”
Both Vanhooser and Ram-seyer encouraged patients to talk to their doctors to make decisions regarding their own breast health.
