Thursday, November 19, 2009

New Guidelines for Mammograms? What?!

According to the United States Preventive Services Task Force (a panel of experts appointed by the federal Department of Health and Human Services to provide guidance for doctors, insurance companies out, folks...policy makers), all women except for those specifically designated as "high risk" should begin having mammograms at age 50 rather than age 40. Furthermore, they should have them every two years rather than every year. And they should stop giving themselves breast examinations.

Interestingly, it was only seven years ago that the USPSTF conducted its last study. At that time, the panel counseled women to have mammograms every year, beginning at age 40. True, the members of the group are now different, but could the data they investigated have changed that much in seven years? Maybe it has, but my initial reaction was to suspect that the health care rationing I've feared under Obama's plan has already begun. Am I crazy?

So far, the American Cancer Society and the American College of Radiology have stridently disagreed with the new guidelines and are refusing to back them up. Both organizations will continue to espouse the old regimen. On the other hand, the National Cancer Institute has promised to reconsider its recommendations due to the USPSTF's findings.

Let's face it. Right now, Medicare is required to pay for annual mammograms, and so are private insurers in every state but Utah. Under the new guidelines, that coverage will likely change.

According to Dr. Karla Kerlikowske, a professor at UCSF, "the message is to get 10 mammograms in a lifetime, one every two years, beginning at age 50" in order to minimize potential harm and maximize potential benefit. The task force concluded that one cancer death is prevented for every 1,904 women between the ages of 40-49 who are tested yearly. That number changes to one death averted for every 1,339 women aged 50-59 and tested yearly, and one death for every 377 women aged 60 to 69 and tested yearly.

To those of you who've hung around here a while, it's no secret that I hate getting mammograms, and I can't honestly say that I'd be sorry to give up having them every year. But I've also had several friends, diagnosed under age 50 by yearly mammograms, who would probably not be with us right now without that earlier screening. I've also had friends over 50 whose lives would almost surely have been lost from fast-growing forms of breast cancer had they not been tested annually. That looks like some pretty big downside from where I'm sitting.

I've always felt some concern about the amount of radiation we receive in our yearly mammograms, but so many of my friends are getting breast cancer that I'm going to side, for now at least, with the American Cancer Society. Ideally, we would all get an ultrasound every year, which works better diagnostically and is entirely free of radiation. Barring that, I've read that the newer mammography machines are both improving results and lowering levels of radiation, thus minimizing potential overexposure.

It's a hard one, and maybe I'm just conditioned to think we need yearly mammograms, but I still can't help feeling suspicious. Doesn't this new revelation come just a little too close on the heels of the health care bill? Isn't the coincidence of this timing just a little too convenient?

I'd love for all of you to weigh in here. I could use a reality check!



Momza said...

You're right, I fear Obama's agenda is going to cause much grief as lobbyists on all sides buy their way into our private lives--esp with healthcare.
We're not going to like where we end up in 4 years.
What can be done?

ben said... conducted a study among 600 about the new guidelines released by the Preventive Services Task Force of the Department of Health and Human Services recommending against regular mammography tests for women under 50 years old. Results found that the majority of physicians (78%) reported that they do not agree with the new guidelines. Furthermore, the majority of physicians (78%) also reported that the advice they give to patients will not change based on the new Preventive Services Task Force of the Department of Health and Human Services guidelines.
More in depth results can be seen at:

karen said...

I think it's very suspicious. I was a little disturbed that Dr. Nancy Snyderman on the Today Show sided so stridently with the new guidelines. She's always been such an advocate for proactive healthcare in the past. It made me wonder whether she was receiving a lot of pressure from NBC to follow the program. She even said that self exam was a waste of time - HUH???? Besides traditional mammogram, there is also a scan that uses heat to find abnormalities. One of my physicians advocates and uses it, but I haven't looked into it as it would probably be expensive. Maybe I should. I think I'm still going to go with the yearly exam unless my insurance stops paying for it entirely. I don't like to go through it, but I do like peace of mind.

jen said...

Lily's favorite teacher was diagnosed with breast cancer right before the school year started. She just had a feeling that she needed to get her yearly mammogram (as it turned out, she was a month early). She isn't fifty, and as aggressive as this form is, she would have died, surely.
For Claudia Bretzing, I say, "Keep mammos every year."
And I plan to have my first one, just as soon as I won't fill the machine with milk!

Karen Sue said...

Shortly after I had my first child I lost a friend to breast cancer. I have another that is fighting right now and a different friend and I walked the BC 3DAY in Cleveland 2 summers ago and then she returned to crew this summer. I heard a Christian comedian once say that a mammogram is when they take a cup and turn it into a saucer. I think about that every time I go. I'm 47 and have had one for the past 7 years. Not ready to stop now..Oh, I think we will see alot of cost-cutting healthcare 'reforms' coming our way. Whether you voted for change or not, be prepared for it. I don't think it will be pretty...

Em said...

great, now i won't have to feel so guilty for not doing them regularly;-) shame on me.

Karen said...

I am really wary of the new 'guidelines.' I watched the Today show yesterday when they had the opposing sides on discussing this issue and I thought the Dr. defending mammograms had 2 good points:

1. The radiation from a mammogram is the same amount you get flying from Denver to New York.

I don't see people driving becuase of radiation levels in airplanes.

2. Isn't that 'small percentage' who are diagnosed between 40-49 with a mammogram worth the extra effort?

I have to admit the Dr. defending the new guidelines explained that most women between 40-49 who have breast cancer were diagnosed but some other means (breast exam, finding a lump, etc.)

But this will change what our insurance will pay for yet again.


Jess said...

I'm of the whole an ounce of prevention school- but that's just me. I can see how the government just doesn't see it that way- it really must stink to have to spend some of their hard earned money on those pesky citizens who are on medicare. I mean sheesh, that would save them loads of cash to spend on something better, right?

Sorry my smarty pants lit on fire for a second. My mom is currently battling breast cancer, and I say THANK HEAVENS for mammograms and diagnostic imaging. Otherwise I'd be an orphan.

Jill said...

I was baffled by it all too but until I read your post I never thought about it coming at the same time as the new health plan...hmmm, kind of obvious, huh? On the other side of the coin, breast cancer has gone way up and there is some talk that perhaps all the mammograms have a part in this. They have a cumulative affect in our bodies. My dr told me last week that one mammogram equals the radiation of over 500 dexa scans for bones. True, dexa scans are considered safe and have very little radiation...but 500!!?

KC Mom said...

You are exactly right...this is just a sample of what we're in for.
I'm just sick about it.

Anonymous said...

I agree with you, Sue. For those of us who view this bill as Manna from Heaven, enlightenment won't occur until we're affected personally by socialized medicine. I fear we babyboomers - those of us who have paid most into our errant tax structure, will be the very ones suffering most. We'll most definitely be discriminated against because of our age.

Darlene said...

It's all just too disgusting for words. I'm 82 and I plan to keep getting those darned mammos until I die. That way at least I won't die of brest cancer.

I'll be glad when Obama just goes away.

Karen Sue said...

I've been talking about this for the past day and no one thinks it is a good idea.
You've just gotta go to one of those walks-ours was 20 miles a day, 3 days in a row. Hottest weekend of the summer in Cleveland. You carry a hankie at all times...wipin' the sweat and wipin' the tears. When the lady in the lawn chair with no hair is holding up a sign that says THANK YOU, you know you can walk 20 miles..when the girl you meet at the pool the night before has already lost 2 sisters to BC, there's no question...

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