Physicians challenge recommendations telling women to delay mammograms

Local breast cancer survivor doesn't agree with changes

By Mara Stine

The Gresham Outlook, Nov 28, 2009, Updated Nov 30, 2009 (4 Reader comments)

The U.S. Preventative Services Task Force issued a recommendation that women 40 and younger should simply talk to their doctors about the benefits and risks of having a mammogram.

File photo / The Outlook

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After years of being told to suffer through the vise-like grip of a yearly mammogram starting at age 40, women are now hearing the breast cancer-detecting test can be put off until they’re 50.

The controversial recommendation from the U.S. Preventative Services Task Force issued Monday, Nov. 16, now says women 40 and younger should simply talk to their doctors about the benefits and risks of having a mammogram.

And those monthly self-exams to perform to detect lumps, bumps or other changes in breast tissue that could be a sign of breast cancer?

Never mind, the task force says.

Women, meanwhile, are left scratching their heads. Go with the new recommendations or stick with the old — the longstanding American Cancer Society recommendation that women 40 and older get yearly mammograms?

For a bit of clarity, The Outlook turned to two local medical professionals with decades of expertise in breast health.

Dr. Nicholas Calley is medical director of radiology services for Adventist Health at Gresham Imaging Center and Adventist Medical Center.

Dr. Nathalie Johnson is medical director of Legacy Cancer Services and Legacy Breast Health Services, which includes all Legacy hospitals, including Legacy Mount Hood Medical Center in Gresham.

Neither doctor is changing longstanding advice to his or her patients: Get a mammogram starting at age 40, sooner if you have a family history of breast cancer.

In fact, Calley even recommends a baseline mammogram at age 35 to compare to future screening mammograms.

He learned about the findings during a recent MRI conference in Washington, D.C. But even with the heads up, he finds them shocking.

Upon returning to work, Calley and his professional peers “just looked at each other and said, ‘This is crazy,’” he said.

His wife agrees. Her response to the task force findings: “Are you kidding me?”

The task force found that although mammograms lower the risk of dying from breast cancer by 15 percent for women in their 40s and 50s, the benefit to younger women is much lower.

Doctors would have to screen 1,904 women, ages 39 to 49, for more than a decade to prevent one death, compared to 1,339 women, ages 50 to 59, and 377 women, ages 60 to 69.

“As long as you’re not that one person,” whose life is being saved, the recommendations are fine, Calley said.

But as to the suggestion that fewer women get simple procedures that detect early stage cancer when it’s treatable: “I just intuitively don’t agree with that,” Calley said. “It’s one of the things we’ve done well in the last 30 years in this country, breast cancer detection and treatment. I’d rather not see us go back.”

Johnson says she understands the numbers: It takes about 1,900 screenings to save one life. She just disagrees with the task force’s conclusion that it isn’t worth that one life. After all, her mother had breast cancer when she was young.

According to the American Cancer Society, the median age of women diagnosed with breast cancer between 2000 and 2004 was 61. Approximately 200,000 women will be diagnosed with cancer this year, about 40,000 of whom will be terminal.

But the task force found that women in their 40s and younger have a higher risk of “harm” from the tests. They’re more likely to have false positives, when something suspicious is detected that turns out to be nothing. A false positive can result in a painful biopsy, anxiety and additional expense.

The data the U.S. task force based its recommendations on was not collected in the United States, but came from less medically advanced nations. So instead of a relatively simple needle biopsy, often done in the U.S., patients reported more painful, complicated and expensive surgical biopsies, skewing the “harm” index, Johnson said.

About 6 percent of women screened with mammograms are called back for more tests, and most of those do not result in a cancer diagnosis, she said.

“I think a lot of people don’t mind because if they do have something, they want to find out early.” After all, what’s the alternative? “If we did less screenings, we’d have less patients get anxious?” Johnson asked. Hardly worth it, she added.

Calley estimates that for every breast cancer diagnosis, there are probably seven to 10 women who receive a false positive or a benign biopsy.

Although doctors have recommended breast self-exams for many years, the task force says there’s no evidence to show they save lives.

“This has us all scratching our heads,” Calley said. “A woman who performs monthly self-exams is going to know her breasts better than a doctor who examines her once, maybe two times a year.

“I mean seriously. You know when something’s different or something’s changed. And sometimes that’s how we find it (cancer).”

“Sometimes people feel a lump that turns out to be OK,” Johnson said. “But I think that’s a fair-trade off for finding the lumps that aren’t. Sometimes people find something that may not have been picked up (by a mammogram) for another year.”

What Johnson finds particularly frightening about the recommendations is that they have caused some women in their 40s to cancel yearly mammograms, saying they’ll be back when they’re 50.

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