For women with no other breast issues, new recommendations to not begin mammogram screenings until age 50 make sense, two local physicans said this week.
The Nov. 17 issue of Annals of Internal Medicine published the recommendations, which were met with both acceptance and a firestorm from the public. The report recommends against routine screening of women 40-49 years old and recommends biannual screening for women 50 to 74 years old.
The study states that “there is convincing evidence that screening with film mammography reduces breast cancer mortality more for women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is for women aged 60 to 69 years.”
The study goes on to state that women are harmed by unnecessary screenings.
“The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests, biopsies in women without cancer and inconvenience due to false-postitive screening results,” it stated.
Drs. David Kemp and Trish Wood, obstetrician-gynecologists with Cotton-O’Neil/Medical Arts in Emporia, spoke this week about the recommendations. Kemp said the findings are based on epidemiology and are focused on reducing costs and reducing the incidence of breast cancer in women.
Wood said as hard as the recommendations are for women to hear and accept, the research and the people who did the research are reputable.
“The people involved are reputable,” she said. “These aren’t flimsy recommendations.”
But, they said, the recommendations are just that — recommendations. The American College of Obstetricians and Gynecologists still recommends the current guidelines — screening mammograms every one or two years for women 40-49 and annually for women age 50 and over.
Wood said the new recommendations are geared toward women who have no problems and no history. Kemp agreed.
“This is what studies like this are trying to show us,” he said. “That if you screen the right population you can deliver health care more efficiently, which frees up more money to care for larger populations of people.”
Kemp said you also have to weigh the costs to the patient who has to go through screening procedures that yield nothing — especially when women are younger and more false positives tend to be detected. He said you have to weigh the psychological impact and the cost impact with biopsies and films.
Women who have lumps, bumps, lesions or a history of breast cancer would still get checked and still get care.
“It’s for women who have no issues,” Wood said.
Women who find or have issues should not be afraid or discouraged from seeking care, she said.
Kemp said many people’s reactions to the recommendations have been mixed.
“It’s more that everybody thinks that it’s just another kick in the pants for women’s health care,” he said, adding that the recommendation’s aren’t designed to diminish the importance of women’s health care.
Wood said she doesn’t ever want to see less emphasis on women’s health care.
“We don’t want there to be a reason for women to not see us,” she said. “There’s still a lot of value in preventative health care and visits.”
Wood said annual visits for a full physical are important in early detection.
“It’s much easier if we can help prevent,” Wood said. “The only way to do that is through routine yearly exams.”
Findings
The U.S. Preventative Services Task Force recommendations:
• No routine screening mammography in women aged 40 to 49 years.
• Biannual screening mammography for women aged 50 to 74 years.
• Don’t teach breast self-examination. “These studies found that teaching BSE did not reduce breast cancer mortality but resulted in additional imaging procedures and biopsies,” according to a summary of the recommendations by the American Congress of Obstetricians and Gynecologists.
The American College of Obstetricians and Gynecologists currently continues to recommend the following services:
• Screening mammography every one to two years for women aged 40-49 years.
• Screening mammography every year for women aged 50 and older.
• Breast self-exams have the potential to detect palpable breast cancer and can be recommended.
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