<img src="http://www.joplinglobeonline.com/images/zope/extra.gif" border=0>Locals react with dismay to new breast cancer screening guidelines<font color="#ff0000"> w/ new cancer screening recommendations and American Cancer Society response</font>

By Emily Younker

eyounker@joplinglobe.com

When breast cancer survivor Sharon Clark learned of a government panel’s new recommendations about some common breast cancer screening methods, she was appalled and almost unbelieving.

“Oh my God, that just blows my mind,” she said.

The U.S. Preventive Services Task Force, a multi-disciplinary government panel, released new recommendations earlier this month regarding mammography and other breast cancer screening practices for women older than 40 who do not face an increased risk of the disease.

The task force recommended against routine screening mammographies for women ages 40 to 49, for which it said the “net benefit is small.”

The panel also recommended that biennial mammography screening begin at age 50. And, it came out against teaching breast self-examination, for which it said there is “moderate or high certainty” that it “has no net benefit or that the harms outweigh the benefits.”

“Age should have nothing to do with the mammogram — period,” Clark said. “Even teenagers should start their breast self-exam because we all know cancer doesn’t care how old you are.”

Clark, 52, was diagnosed with breast cancer at age 33 after discovering a lump while doing a self-exam.

“Probably over half the people I personally know who’ve been affected by breast cancer, they’ve discovered the lump from a self-exam,” she said. “I can’t imagine, if I hadn’t done my breast self-exam, it would have been nine months before (a scheduled checkup), and I’d hate to think of where I’d be.”

Better balance

The task force concluded in a report published in the Annals of Internal Medicine that biennial screenings are more efficient than annual screenings, and provide a better balance of benefits and harms.

“Slow-growing tumors are much more common than fast-growing tumors, and the ratio of slow- to fast-growing tumors increases with age, so that little survival benefit is lost between screening every year versus every other year,” the task force wrote. “For the small subset of women with aggressive, fast-growing tumors, even annual screening is not likely to confer a survival advantage.”

The reason for suggesting that women wait until age 50 for a mammogram, the task force said, is that early and frequent mammograms are often more harmful — leading to unnecessary tests and biopsies — than beneficial.

The recommendations are meant to give women the information they need to avoid breast cancer while minimizing the harms of mammography, said task force member Dr. Michael LeFevre, a professor and associate chairman of the family and community medicine department of the University of Missouri-Columbia School of Medicine.

LeFevre said the recommendation for women in their 40s is not meant to dissuade them from breast cancer screening, but rather to help them make the right decision for themselves.

“The age at which to start screening is less clear,” he said. “Younger women will have more false-positive results and unnecessary biopsies. In the context of the balance of benefits and risks, the decision (to get a mammogram) should be left up to the individual.”

Dr. Duane Myers, radiation oncologist at St. John’s Regional Medical Center in Joplin, said he doesn’t agree with the recommendations. He said he treats many women in their 30s and 40s for breast cancer, and many of them have more aggressive cancers than women 50 or older have.

He said that based on his 20 years of experience in the field, “The best way for a woman to find cancer early so it’s treatable and curable is with a yearly mammogram and breast self-exams.”

Myers said he thinks women should continue to get a mammogram yearly beginning at age 40.

“Breast cancer will kill you,” he said. “The technology is there, and if a woman is able to afford it and has access to it, there’s no reason not to get (a mammogram).”

Know your history

Having been diagnosed with breast cancer at age 26, Sarah Burkybile, 29, is another staunch supporter of early detection methods.

“If it wasn’t for self-exams and knowing our bodies, we wouldn’t have found our breast cancers early, and (we) would be in a worse state,” Burkybile said.

Burkybile said the Hope 4 You Breast Cancer Foundation board, composed of local survivors and physicians, came to the consensus that regardless of screening guidelines, women should be in control of their health and do what they think is right for them.

“We still feel that it is extremely important to do breast self-exams (and) know your family history,” said Burkybile, a board member. “Just be your own patient advocate. If you feel like you need to have a mammogram, have a mammogram done. Try not to let guidelines dictate what you do for your own health.”

The American Cancer Society also will continue to recommend an annual mammography and clinical breast exams beginning at age 40. Otis W. Brawley, the society’s chief medical officer, said in a statement that issues with mammography, such as false alarms or the oversight of some cancers, do exist.

“But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives,” he said in the statement. “As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: This is one screening test I recommend unequivocally and would recommend to any woman 40 and over, be she a patient, a stranger or a family member.”

The Susan G. Komen for the Cure Foundation advises that the age at which a woman gets a mammogram should be decided by her and her health care provider.

Myers, at St. John’s, said he thinks the panel’s recommendations offer a glimpse of what a socialized health care system could look like.

“You can’t pay for the best health care needs of everybody in a socialized system,” he said. “If everybody has equal access ... then you start making trade-offs. Instead of giving women mammograms at age 40, you start at age 50.”

But task force member LeFevre said the panel was created to be apolitical.

“There are no politics involved at all in the task force or its recommendations,” he said.

LeFevre said the task force did not look at health care costs during its study, nor are its recommendations an attempt to ration health care.

Additionally, he said, the task force reached its recommendations during the summer of 2008. Because of the extensive review system that followed, the timing of the publication with the national health care debate was coincidental, he said.

More guidelines

Breast cancer screening recommendations aren’t the only ones that have been updated recently.

In an unrelated and seemingly less controversial announcement, the American College of Obstetricians and Gynecologists now recommends that women get their first cervical cancer screening at age 21 and that they be rescreened every two years. Women older than 30 are advised to be rescreened every three years.

Under the previous recommendations, women were advised to get their first screening at age 21 or within three years of becoming sexually active, whichever occurred first. Annual rescreenings were recommended.

Moving the average first screening to age 21, the group said, is a “conservative approach to avoid unnecessary treatment of adolescents.”

The American Cancer Society has similar recommendations for women.

Myers said he thinks these recommendations are sensible, partly because a vaccine for human papillomavirus, which causes most cases of cervical cancer, is now routinely recommended for 11- and 12-year-old girls.

As more girls and young women get vaccinated against HPV, they can get by with less frequent screenings for cervical cancer, he said.

“To me, there’s more sense to that (recommendation),” Myers said.

Certain groups of women, such as those with HIV or those with cervical abnormalities, are still encouraged to receive annual screenings for cervical cancer.

‘Right for you’

“The fact that the (U.S. Preventive Services Task Force) and the American Cancer Society now have different screening recommendations for women in their 40s simply reinforces the importance of educating yourself about the potential risks and benefits of screening, talking with your physician and making the decision that’s right for you.”

— Statement from the Susan G. Komen for the Cure Foundation

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