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New mamogram guidelines? Cancer doesn’t wait

Categories: Hacking Life, Uncategorized

4 comments

I’ve got a couple years until I hit the big 4-0, but a recent cancer scare has made me start taking my health more seriously. There’s a history of different types of cancer in my family, some fatal, on both sides. So when the new guidelines for mamograms came out last month, stating that annual screenings were no longer recommended for women younger than 50 (and that self-exams weren’t helpful, either), I wasn’t sure what to make of it. Wait 10 more years to start screening for something that’s already in my family? Get tested for the BRCA1 cancer gene, and then decide? What?

I’ll admit that my immediate reaction to the new guidelines was less practical and more along the lines of “if this was a man’s issue, they’d be recommending more screenings, not less.” After all, most health insurance plans cover Viagra but not The Pill, right? And breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. (More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.) Given the political focus on health reform, it’s also easy to jump to the conclusion that this is really about heath insurance companies wanting to avoid paying for mamograms. But breast cancer does, indeed, affect men, too. And the data used by the government task force to determine the new guidelines has been around for years, according to the Los Angeles Times.

The new guidelines are actually more in keeping with those in other countries. Though the American Cancer Society has long recommended that women get annual mamograms starting at age 40, international guidelines call for screenings to start at age 50, just as the new US guidelines do. The World Health Organization recommends screenings every other year; in Britain, women get screened every three years.

What if you have a history of cancer in your family, or you test positive for the BRCA1 gene?
“You should talk to your doctor and make an informed decision about whether mammography is right for you based on your family history, general health, and personal values,” said Dr. Diana Petitti, vice chair of the task force, in a statement.

So why change the guidelines at all? According the Associated Press, the task force concluded that “getting screened for breast cancer so early and so often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women’s odds of surviving the disease.”

There’s the key word, right there: surviving. And I agree that it’s a valid way to determine the usefulness of the screening. But what about the patient’s quality of life? How does the treatment of the disease change when a tumor is discovered later rather than earlier? There’s a huge difference — in cost, in stress, in pain, in recovery — between a lumpectomy and a radical mastectomy.

Actress Christina Applegate had a double mastectomy last year, a month after she was diagnosed with breast cancer — at age 36. She started having mamograms, she told Good Morning America, when she turned 30.

Not 50.

“If this had been caught a year from now, or when I was 40, I probably wouldn’t be able to live through this,” Applegate said.

And that’s my fear. The “what if?”

What do you think of the new guidelines?



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4 comments so far...

  • The guideline in the US used to be 50. (My doc still has the old schedule on her wall.) So my first question would be, why did they lower it to 40 for all women? Especially considering that other countries still target 50. I can think of several reasons other than public health to lower the standard recommended screening age, including rewarding the developers of the mammogram technology etc., spreading the cost over a larger population, etc. This concerns me not because it’s inherently wrong, but because radiation isn’t without negative side effects. More is not necessarily better.

    There are certainly women who are in higher-risk groups who should get earlier mammograms. I have that concern for colon cancer, and I still can’t get a colonoscopy unless I first develop “symptoms” that I actually have something wrong in my colon. As we all learned in 9th grade health class, many of those symptoms (bleeding, etc.) don’t show up until the cancer has taken a pretty solid hold. So I wonder: are high-risk women finding it hard to get mammograms paid for if it isn’t an across-the-board recommendation? If that is the issue, then can’t we target the solution to those women?

    My preference is for medical technology to be improved to the point where doctors can use more non-invasive, non-harmful, relatively inexpensive tests to determine who is at higher risk of these diseases, and then use the more invasive technologies for those high-risk groups. Actually they are developing significant technologies along this line, but they are not inexpensive at this point, and thus are not yet ready to be widely used.

    SKL  |  December 8th, 2009 at 3:47 pm

  • (Actually, similar anti-screening suggestions are coming down for prostate cancer also, so it’s really not fair to phrase this as women-vs-men, even setting aside the percentage of men who do get breast cancer.)

    Personally, I think that guidelines are for the average Jane. With your history, I wouldn’t wait to get tested. You (potentially) have a higher risk, and so for you I think it is worth the chance of false positives. If only for your peace of mind.

    For the average Jane with no history of breast cancer, though - that is where I think these new guidelines make sense.

    Rini  |  December 8th, 2009 at 5:15 pm

  • The insurance companies have said that the new recommendations won’t change their coverage of mammograms… but I think it’s handy that the recs came out right as the health reform bill is in the works, which will likely set the minimums for private insurance coverage in the future…

    That said, I do think doctors will still rely heavily on family history and will continue screening younger women with risk factors.

    Lee  |  December 9th, 2009 at 9:54 am

  • I think they lowered the age partially because at 40 the odds go up and younger women were finding about their cancer risks (BRCA testing) and wanting more testing earlier.
    I think the guidelines are actually probably correct for women without a history, however there ought to be ways to change requirements for those with cancer histories. I think anyone with a history of a cancer type in the family should be able to be screened at regular intervals without hassle. My mom faces the same thing that SKL notes; she can point to those who died of colon cancers but couldn’t get that screening until she reached the designated age.
    Instead of blanket screenings, we need to find proper ways to do targeted screenings. But then we’ll have to get the laws changed so to remove health plan discrimination against those with identified risks. We don’t want to become Gattaca.

    Mich  |  December 10th, 2009 at 2:39 pm

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