From The Naperville Sun:
Mammograms: Is it ever too early?
Local docs say mammograms should start at 40
November 21, 2009
By ERIKA WURST and Josh Larsen
To mammogram or not to mammogram?
That was the question raised this week by a government panel of scientists and doctors who claim that 50 is the new 40 when it comes to the age when women should get the cancer screening test.
The group of experts on the U.S. Preventive Task Force said most women don't need mammograms in their 40s, as the American Cancer Society has recommended for nearly two decades, and should get one every two years starting at 50 instead.
"That's just crazy," said Dr. Darius Gilvydis of Naperville Radiologists, which has 17 specialists on staff at Edward Hospital. "For over 20 years, we have been successfully working to decrease deaths associated with breast cancer. This would put an immediate stop to that decline."
Gilvydis, a breast specialist who trained at Yale University before joining Naperville Radiologists about 18 months ago, said he has found numerous cancers in women below 50 and that "they are often aggressive lesions.
"Just yesterday, I detected breast cancer in a woman in her 40s," he said.
Getting a mammogram at the age of 40 may have saved Susan Sebastian's life.
The former Naperville resident went in for a routine exam in September 2008. Because her 40th birthday was two months away, her doctor prescribed a mammogram screening at Edward Hospital. The scan detected a lump; she was diagnosed with Stage 3 cancer in the spring of this year.
"In September, I had a clean bill of health, and in April, I'm in surgery," said Sebastian, who elected to undergo a double mastectomy.
Sebastian first heard of the taskforce's new recommendations from friends.
"I feel a little bit of shock and anger that they would consider that," she said of the decision. "Why would we want to move backwards? You would think we'd want to be proactive and move forward."
In explaining its decision, the Preventive Task Force said early and frequent screenings often lead to false alarms and unneeded biopsies without substantially improving a woman's odds of survival.
According to the taskforce, the number of lives saved by doing mammography every two years is almost the same as that of doing it every year, while the risk of false diagnoses and unnecessary biopsies are likely to be reduced by half.
"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chairman of the panel.
Gilvydis, who advises yearly screenings and monthly self exams beginning at age 40, sees other motivations behind the panel's recommendation.
"This is really the first step in rationing health care," he said. "I think it's a cost savings they're trying to accomplish.
"Any and all screening tools do increase the number of false positives," he continued. "However, the benefit from mammography has been proven by numerous studies to outweigh its risk."
Mary Maryland, president of the American Cancer Society's Illinois division, agreed. False positives are a legitimate concern, she said, but "the trade-off of saying because of this do not get a mammogram in your 40s is unacceptable."
As for the U.S. Department of Health and Human Services, Secretary Kathleen Sebelius said federal policy on who should get breast cancer screening has not changed.
Sebelius issued a statement Wednesday saying the U.S. Preventative Task Force does "not set federal policy, and they don't determine what services are covered by the federal government."
Sebelius called mammograms "an important lifesaving tool" and said women should "keep doing what you have been doing for years."
Joe Kash, a medical oncologist at Edward Hospital, also disagreed with the taskforce's recommendation against screenings for women in their 40s, but he did say some of the reasoning behind the decision is worth consideration.
"It deserves a discussion of those benefits and downsides," he said. "My opinion is I let the patient decide."
When asked what he would recommend to his own wife, Kash said, "Knowing my wife, I think she's going to continue to get her mammograms. But if she decided to hold off, I'd respect that."
Mary Alice McMahon, a nine-year nurse at Naperville Radiologists, expressed anger at the taskforce's decision.
"Personally I'm appalled by it because we see so many young people who would not come in (under the new recommendations)," she said.
McMahon said that because undergoing a mammogram can be a painful and uncomfortable experience, women might be eager to use the taskforce's position as a reason for not having one done.
"If somebody tells you you don't have to do it for another 10 years, you want to believe it's true," she said.
Gilvydis said such beliefs could be disastrous.
"It is so upsetting," he said. "The only certain thing that will come from this is a deadly effect on American women."
New breast cancer report:
The new U.S. Preventive Services Task Force guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations. The panel's report says:
- Most women in their 40s should not routinely get mammograms.
- Women 50 to 74 should get a mammogram every other year until turning 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)
- The value of breast exams by doctors is unknown. And breast self-exams are of no value.
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