Monday, November 16, 2009

Task force opposes routine mammograms for women age 40-49 - are they for real???

I just read this CNN article tonight.  I cannot believe what I just read.  Some task force, under the umbrella of the US Dept of Heath and Human Services, just said that mammograms aren't necessary every year for women age 40-49.  This changes the previous guidelines which recommended mammograms as early detection for women over age 40.  The article goes on to say, that "...[W]hile roughly 15 percent of women in their 40s detect breast cancerthrough mammography, many other women experience false positives, anxiety, and unnecessary biopsies as a result of the test, according to data."

Please, provide me with the percentage of women who experience false positives, anxiety and unnecessary biopsies as a result of mammograms.  Is it more than the 15 percent who saved their lives by detecting breast cancer?  And, even so, having a mammogram didn't kill them.  Neither did the anxiety or unnecessary biopsies.  But what would have happened to the 15 percent of women who detected breast cancer had waited until they were 50?  What data shows how many of those women had a history of breast cancer in their families or felt a lump?  What if they just went in because they knew it was good to have a baseline for future mammograms and were surprised with the fact that something did show up on the mammogram and that they did find out earlier rather than later?  What percentage of those women were able to, or decided to, save their breasts and just have a small lumpectomy?  What percentage of those women who had mastectomies and were able to prevent the recurrence of breast cancer?  What percentage of those women who detected breast cancer in their 40s were able to avoid chemotherapy because the cancer had not yet spread to their lymph nodes or, worse yet, some other part of their bodies?  OR, worse yet, what percentage of those women STILL had to undergo chemotherapy because the type of breast cancer they had was so aggressive that it would have spread, even if it had not yet done so?  What percentage of those women were able to save their lives because they went to doctors who trusted these guidelines and sent these women for mammograms accordingly?

This is a very hard article for me to read given the fact that I am still undergoing treatment for breast cancer at age 38.  For those of you unfamiliar with my blog, go back to February & March 2009 articles which discuss my breast cancer discovery ON A FLUKE because I met a new doctor who gave me a breast exam and said I had lumpy breast tissue so I should go get a mammogram.  She felt no lump, I had no history.  In fact, my OB/GYN who I had seen regularly for two years before then never even MENTIONED a mammogram because there was no reason for it.  When I read an article like this, it is hard for me to FATHOM what I would have gone through if the guidelines were set for a higher age to begin mammograms.  If the recommendation is to wait until age 50, would my internist still have thought to send me for a mammogram?  I highly doubt that. 

This doesn't even begin to discuss what health insurance companies might decide to do based on this task force recommendations.  Okay, while I want to believe that insurance companies will still fully cover mammograms, who knows?  Everyone is cutting costs.  Maybe insurance companies will deny mammograms for women who do not fall under a "high risk" category.  I don't know, I don't want to think about that.  Because I assure you, if the test had not been covered by my health insurance, I GUARANTEE you that I would not have gone for a mammogram.  No way, no how.  Before my diagnosis, I would have told you I was 100 percent healthy.  Some tests might be considered unnecessary, but I just don't see how this task force just pushed back the age for women to get annual mammograms to age 50...oh, and I know this isn't well thought out or well written.  I am still recovering from my surgery of having breast tissue expanders exchanged for final breast implants.  Not even a week old.  I am still on pain medication and have drains running out from under my arms.  This just hit a raw spot.  More to come later when I can properly articulate how PISSED OFF I am.  Congress, here I come!


  1. My doc also recommends a baseline mammogram at 35 and I will be having my first in 2 weeks along with an ultrasound. Just call me Ms. Lumpy Fibrous Boobs. I am 37 and didn't even think about getting the mammogram yet until doc mentioned it yesterday and there is no way I'll miss that appt. after reading your story.

    Hang in there, hope that you feel better very soon from the tissue expander surgery.

  2. I'm 37, was refused mammograms for 3 consecutive years when I requested it at my annual physical and then this past year I was diagnosed with STAGE IIIC triple negative breast cancer. That panel can shove their guidelines straight up their colons as far as I'm concerned. I have no family history of bc, tested negative on the BRCA gene mutation, but I had a hunch and nobody would listen b/c I was "too young". F*** them! I'm so pissed about this. The age for routine screening should be LOWER not higher. UGH. I will live beyond the statistics for this illness just so I can kick some policy ass LOL - and see my son get married and give me grandchildren. But if I had not insisted on a mammogram this past spring and went along with these new guidelines I'd be dead within 5 years.

  3. Let me know when you head to Washington - I'll go with you!

  4. I second that. I was so pissed off when I saw that report, I nearly lost my mind.

  5. I totally understand why you're upset about the new guidelines, but I think you're misreading the statistics. Of the women in their 40s who are diagnosed with breast cancer, 15% of the cancers are found through mammography. The other 85% are found through lumps or pain or some other physical symptom.

    Another 15% figure is going around: that there is a 15% reduction in breast cancer deaths because of mammography. The studies seem to suggest that the figure might be as low as 9% reduction in this age group. But even if you take 20% reduction, it is the difference between between a death rate of 0.4 and 0.5 That is for ALL mammography. For women in their 40s, mammography saves 1 life in 10,000 women screened.

    One life in a 10,000 is still incredibly important, of course. But the risks to women with false positives are also incredible. A full third of women who have annual mammograms during their 40s have false positives at some point during the decade. These lead to more radiation, more surgery with all of its complications (including very rare death), and many women with significant breast tissue removed as well--all unnecessarily. In addition, the risk for breast cancer in later years may increase for women who have annual screening during their 40s--even if they have no false positives--because of radiation over time. The false positives are substantially reduced as women's breasts change with age, so mammography at 50 has a much clearer risk/benefit profile.

    It is very hard to know how to balance risks and benefits in this analysis. Clearly, mammography was the right thing in your case and in many other women's cases. But other women have been actively hurt by annual screening as well.

    What the task force did was withdraw their recommendation to screen all women, not recommend against it. Instead, they said that decision should be made by the women themselves, in discussion with their doctors.

    It seems to me we need a huge push to do the things that can actually reduce the amount of breast cancer: regulate enviromental pollutions, encourage breastfeeding (which has a significantly more impressive impact on the number of breast cancer deaths), etc.

    We also need a huge push to find both screening and treatment that is more effective in this age group and less harmful. Their are some things coming down the pipeline, it seems.

    I do hope my comment has not angered you. I know it is an especially personal issue for you. I am a brain tumor survivor (diagnosed at 25) and know how hard my own health care battles have been. I wish you well in your continuing treatment.