No more mammograms for young women, panel recommends

On Monday, the American Cancer Society was seeing red courtesy of a new set of government guidelines for breast cancer screenings that sent shock waves through the organization -- and the entire country.

Recently, the American Cancer Society backpedaled on screenings for some screenings. But they've remained consistent on their position on mammograms.

A government panel consisting of doctors and scientists has issued their guidelines for mammograms, stating most women should skip the screening until age 50 -- something that sharply conflicts the American Cancer Society's decades old recommendation for all women age 40 and over to be screened annually.

The task force went on to state that self-exams aren't needed, either. And women shouldn't be taught to do them.

Just don't tell that to Good Morning America co-anchor, Robin Roberts. In July, 2007, the newscaster discovered a lump in her right breast which turned out to not only be cancerous -- it was an aggressive form of cancer that required surgery, chemotherapy and radiation. Thank goodness she was taught to self examine.

Too much anxiety

The U.S. Preventive Services Task Force concluded that getting screened for breast cancer "early," before age 50, and so often (annually) is harmful. They claim annual screenings cause too many false alarms, unneeded biopsies and the corresponding anxiety without substantially improving women's odds of surviving the disease.

"The benefits are less and the harms are greater when screening starts in the 40s," Dr. Diana Petitti, vice chair of the panel told the Associated Press.

Some researchers claim screenings for young women save about five out of every 1,000 women screened.

"I resent the government issuing a statement saying I'm indispensable," says Terri Anderson, a 38-year-old breast cancer survivor with no family history of the disease. "I worry what this message will send to women and how it will affect their [insurance] coverage of these screenings."

Anderson's concerns aren't completely unfounded. The task force's stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group, has said insurance coverage isn't likely to change because of the new guidelines.

The guidelines, which are for the general population, not those at high risk of breast cancer because of family history or gene mutations, say:
  • Most women in their 40s should not routinely get mammograms.
  • Women 50 to 74 should get a mammogram every other year until they turn 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.
  • Medical groups such as the Cancer Society have been backing off promoting breast self-exams in recent years because of scant evidence of their effectiveness. Decades ago, the practice was so heavily promoted that organizations distributed cards that could be hung in the shower demonstrating the circular motion women should use to feel for lumps in their breasts.
Firing back

These new guidelines have polarized the breast cancer community -- and irked those whose lives have been personally impacted by the disease.

The American Cancer Society is concerned the government task force's guidelines will confuse women. And as a result, they may elect not to get screened at all.

"This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.

"The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not," Brawley wrote.

When Geri Moran was 40, her doctor insisted she get a baseline mammogram--even though there was no family history of breast cancer. "That mammo saved my life. The tumor was small but in such a place that had I waited until symptoms presented, it would have most certainly been too late to save my life," she says.

"I am now a 21-year breast cancer survivor. Even though I was, allegedly, only one of 1,900, I like to think that my life was worth saving," says Moran.

The government panel's stance "is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," Brawley's statement said. The Cancer Society feels the benefits outweigh the harms for women in both groups.

"As the husband of a survivor, I certainly feel I was worth it," Bill Anderson says. "My three children, Terri's parents, our family and friends all agree."

For now, several medical groups, including The American College of Obstetricians and Gynecologists, are sticking with the American Cancer Society's recommendations. "Thank goodness," says Anne Hader, a 43-year-old who's had annual mammograms for 3 years. "I'm not willing to risk my life. I don't want to take the chance that I could have cancer that may or may not be deadly or slow-growing just because the government says I'm not worth saving."

One theory that seems to have influenced these newest guidelines is that in most women, breast cancer tumors are slow-growing -- a likelihood that increases with age. So some say switching to bi-annual screening presents little risk.

Sound off: Will the government's new guidelines impact your decision to have a mammogram? Do you think the task force got it right or wrong?

Gina Roberts-Grey is a freelance writer specializing in consumer issues.
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