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Government panel recommends fewer and later mammograms, no self-exams

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new mammogram recommendations 40 50 task force Most women would do fine to hold off until age 50 for their first mammograms and skip self-exams for breast lumps altogether, according to new government recommendations released Monday that came as a surprise to many in the medical community—and women in general.

The report, issued by the U.S. Preventive Services Task Force and published online in the Annals of Internal Medicine, asserts that women can push back the date of their first mammograms by a decade (from the current recommendation of 40 years old), and healthy women from 50 to 74 should undergo the screening every other year, rather than annually. The recommendations cover healthy women who do not have a family history of breast cancer (or the BRCA1 or BRCA2 gene mutations), and the authors make clear that they lacked sufficient data to support recommendations for those in these risk groups.

The recommendations are an effort to cut down on the high number of false positives (and resulting biopsies and anxiety) as well as frequent over-diagnosis (and subsequent unnecessary treatment) produced with current screening methods. One in 1,904 breast cancer deaths in women ages 40 to 49 would be prevented under the old screening regimen, the authors of the report note. The new screening schedule "achieves most of the benefit of annual screening with less harm," the task force reported. Others argue, however, that any preventable deaths should be avoided with continued early screening.

As the second most common cancer killer in U.S. women (which is projected to cause more than 40,000 deaths this year), breast cancer is a difficult affliction to shy away from, and many organizations—and doctors—have come out against the new analysis. "We are reluctant to recommend changing a proven program that has helped to save lives," Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society, told Bloomberg News.

Others are embracing the results. "This is our opportunity to look beyond emotions," Fran Visco, president of the National Breast Cancer Coalition, told The New York Times. It may also be an incentive to improve pinpointing actual risk: "One of the big things that this new information should be pushing us toward is better breast cancer risk assessment," Freya Schnabel, director of breast surgery at New York University Langone Medical Center, told Forbes. And that goes for self-examination as well, she noted: "Instead of giving people elaborate instructions to do self-exams, we should educate them to pay close attention to changes in the bodies."

These new guidelines come amidst a growing swell of critical analyses of the effectiveness of routine screening in general. A study published last month in Gut found that there was not sufficient benefit to recommend routine screening for pancreatic cancer, even in those with high genetic risk. And a report published earlier this year in the Journal of the National Cancer Institute found that frequent prostate cancer screening had led to the treatment of tumors in about 1 million men (since 1986) that would not likely have been fatal and may have even remained asymptomatic.

The number of women who die from breast cancer has declined about 2 percent a year during the past two decades, according to a report issued last month by the American Cancer Society. Part of that drop has been attributed to improved early detection through screening, and many have voiced concern that these new suggestions will lead to a decrease in detection when it matters.

Much of the rationale behind the recommendations focuses on the cancer itself. Women under the age of 50 are more likely to get estrogen-receptor negative cancer, which is quicker and more difficult to detect—especially in younger, denser breasts, Karla Kerlikowske, a University of California, San Francisco physician and author of an editorial that accompanied the report, explained to Forbes. Those who are older, however, often have tumors that are estrogen-receptive positive and are easier to see in mammograms.

Many are concerned the recommendations could be integrated into insurance and other policy, making it more difficult or expensive for women to get mammograms before 50 (which are still covered by insurers in most states). Others, especially cancer advocacy groups, worry that the new guidelines will prove confusing or be another excuse to put off advised testing.

For now, however, the recommendations are just that and nothing more. "Patients will have to start thinking about where their values lie," N.Y.U.’s Freya Schnabel told Forbes. Diana Petitti, an epidemiologist at Arizona State University in Tempe and vice chair of the task force agreed: "This is not a blanket recommendation not to worry until age 50," she told Bloomberg News. "It’s a recommendation to have a discussion with your physician to better understand the trade-offs between starting exams now and starting later."

Historical image of a woman undergoing a mammogram courtesy of Wikimedia Commons/U.S. National Institutes of Health/National Cancer Institute

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  1. 1. fyngyrz 7:47 pm 11/17/2009

    My lady found her lump — and yes, it was cancer — with a self-exam. That is one data point that convinces me utterly that we’ve got another chunk of really bad advice from people who shouldn’t be involved in such advice anyway. Don’t these idiots have bridges to maintain and a country to withdraw from?

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  2. 2. hawkeye 2:01 am 11/18/2009

    "Most women would do fine to hold off until age 50". Meaning that the "statistical outliers" who develop the disease before age 50 would be S. O. L.

    The obvious intent of these recommendations is to save money for insurance companies.

    "Lies, damned lies, and statistics".

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  3. 3. ian_the_chemist 6:52 am 11/18/2009

    It is difficult to quantify the damage done by false positives or overenthusiastic treatment – with male prostate cancer the chemotherapy used to treat men with non aggressive forms may well in many cases have done more damage than the cancer. A rational statistical assessment of when more people will be detected with fewer false positives must be part of the design of any screening strategy. Any screening program will let some cancers slip through the net and to screen people at low risk or screen too regularly may actually make the problem worse not only in terms of cost but also in terms of the numbers of false positives. All these cost/risk/benefit factors must be offset when designing a policy – simply to say "screen everybody as early as possible and take no chances" might actually harm the people we attempt to protect.

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  4. 4. krohleder 9:18 am 11/18/2009

    I think someone had way to many martinis on there yacht with one of the insurance executives.

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  5. 5. Spiff 2:52 pm 11/18/2009

    Think about it! THIS is the panel that will decide IF you need medical help!! This is the "change" that some want…IF the Pelosi/Obama health bill becomes law we can look forward to an early grave!

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  6. 6. jack.123 3:00 pm 11/18/2009

    As most women will tell you a self exam is an easy thing to do while showering,Why would a goverment panel in their right minds suggest it be stopped?I hope most women don’t take this advice.A lump isn’t a false anything.Its a call to action.My sister does so often and I am glad she cares for herself this way.Now if I could only get her to quit smoking.

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  7. 7. bostonprof 9:50 pm 11/18/2009

    This is NOT any kind of panel that will decide such things. What an idiotic comment. Read the comment from Ian_the_chemist above for some sense. ANY screening program has to be itself screened for relevancy and cost/benefit ratios and the most basic of all principles: "First, do no harm." If you can’t be rational about breast cancer, then think about something else like the prostate cancer screening Ian discusses very briefly above. Or think about trying to screen for lung cancer by taking chest x-rays… if you do it too often in a context that is not likely to correctly detect much, the harm from the radiation itself can easily outweigh the benefit even before cost is considered. When cost is considered, and it must be, since we don’t have the resources (and never will) to do everything that could be done for everyone, that may only shade it a little. Cost/benefit analysis is being done in our current health system plenty now, and in fact, we probably shoulbe be doing much more of it. Despite throwing massive resources at health, we have not been very effective in achieving better outcomes compared to most other developed countries. If you don’t understand these things, take a couple of introductory courses in public health or health policy.

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  8. 8. webeflyin 12:22 am 11/19/2009

    The issue I think most people are having with the panel’s recommendation deals with not doing self-exams. Self-exams don’t cost anything. Cost/benefit analyis on that one? Hmmm . . . I haven’t taken a couple of introductory courses in public health or health policy, but . . . I think it was irresponsible for the panel to even suggest that self-exams are not important.

    My mom had her annual exam in July, no lump was found. In August, while doing her monthly self-exam, she found a very small lump–she described it as "pea"-sized. In late August, her doctor did a biopsy–it was cancer. In late September, she had a mastectomy, and her tumor had grown to 2.5 cm. Her cancer was graded as being the most aggressive (I’ll spare you the details of her pathology report). My point? Had she waited until next July when her next annual exam would have been due and she would have her breasts examined by a doctor, she most likely would have had a much worse prognosis than the one she has now. Her self-exam did not cost anyone a cent, but to me and her and our family. . . it’s priceless.

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  9. 9. hawkeye 2:18 am 11/19/2009

    Spiff, why don’t you take your right wing politics, and stick them where the sun doesn’t shine? Nobody here is interested in your politics and right wing propaganda. I’m sorry you’re so upset with us for voting a black man into the White House, but that’s your problem. Go tell your problems to your Klavern.

    We’re talking about a life and death situation that affects our mothers, wives, daughters and all the women we care about. The problem this unbelievably bad advice creates is the excuse it can give insurance companies (one of your republican constituencies) to deny coverage before age fifty.

    I understand the cost-benefit argument and the problems with false positives, but this approach essentially writes off women who develop early disease. There has to be a better way.

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  10. 10. CathyB3 5:18 pm 11/19/2009

    The original study was done in England. The problem lies with the interpretation of the findings.

    The screening included the mammogram, personal breast checks and breast checks by a physician. It was found that screening before age 50 resulted in a 15% decrease in the death rate due to breast cancer. This decrease was deemed to be to little to justify continued screening.

    Too little? Not if it is you or one of your loved ones.

    Manual breast exams were pronounced to be completely ineffective. I don’t know about those English girls and doctors, but in America manual exams are a major source of breast cancer detection. Maybe we know something they don’t know.

    This seems to be a case of a study being turned into junk science by what appear to be vested interests.

    Ignore it and take the best care possible of yourself.

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  11. 11. hawkeye 2:01 am 11/23/2009


    "Left wing politics"? Why do you right wing nutjobs always have to inject politics into every discussion, of any subject, no matter how inappropriate it may be?

    Not that I owe you any kind of explanation of my politics, but I was a registered republican until two years ago, when I became an independent, out of disgust with what the party had become.

    Now – the discussion here is about breast cancer screening guidelines, not "new goverment death panels". Could you please stick to the subject? And by the way, we have had "death panels" for many years; they work for the insurance companies. The current legislation seeks to eliminate them.

    Once again, your obsession with President Obama indicates that your real problem is racism; you can’t stand to see a black man in the White House. I suppose you also think that the Holocaust never happened, Obama was born in Kenya, biological evolution is "just a theory" and the UN is preparing to invade New York and Washington, using black helicopters.

    And you don’t want "government interfering in the doctor/patient relationship"? How then can you justify legislation outlawing abortion? And how do you justify the Bush administration’s holy war against medical marijuana, even to the point of violating the sovereignty of the State of California, by raiding facilities that were legal under California law? So much for "state’s rights".

    Now read my lips; we are talking about SCREENING FOR BREAST CANCER. If you have no interest in that, I suggest you visit the Fox News website; that might be more to your liking.

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  12. 12. johnrock 5:30 am 03/8/2010

    their is really some good information regarding woman’s disease ,i think that every women should go through his article.
    This going to help them.
    <a href="; rel="dofollow">mls</a>

    Link to this
  13. 13. johnrock 5:31 am 03/8/2010

    their is really some good information regarding woman’s disease ,i think that every women should go through his article.

    <a href="; rel="dofollow">mls</a>

    Link to this

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