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November 18, 2009

New breast cancer advice draws fire

Some professionals not pleased with revised screening guidelines

By Sue Loughlin

TERRE HAUTE — As a breast cancer survivor, Sue Jarvis understands the importance of early detection.

Her discovery of a small lump during a self-exam eventually led to a cancer diagnosis, and her battle with the disease took her through surgery, radiation and chemotherapy.

In February, she’ll be a 15-year cancer survivor.

Understanding the importance of early detection, Jarvis is floored by new government task force recommendations that state most women don’t need a mammogram in their 40s and should get one every two years starting at 50. The U.S. Preventive Services Task Force also stated in the new guidelines that breast self-exams do no good.

“That blows me away,” said Jarvis, who also is the Hux Cancer Center director of oncology services. “It’s so personal to me.”

She knows of many women in their 40s diagnosed with breast cancer. Mammograms and early detection “have saved their lives,” she said.

The task force recommendations “stirred a lot of conversation among our providers and specialists,” she said.

The Hux Cancer Center will continue to adhere to the recommendations of the American Cancer Society, which call for yearly mammograms starting at age 40.

Also for that age group, clinical breast exams done by a physician should be part of a woman’s annual health exam, Jarvis said, again based on American Cancer Society recommendations.

Jarvis believes that “early detection is protection” and it saves lives. She recommends that if women have questions, they talk to their physicians.

The government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival, according to an Associated Press news story.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.

The new advice says:

n Most women in their 40s should not routinely get mammograms.

n Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force’s previous guidelines had no upper limit and called for exams every year or two.)

n The value of breast exams by doctors is unknown. And breast self-exams are of no value.

The American Cancer Society has publicly disagreed. Dr. Otis Brawley, the cancer society’s chief medical officer, said in a statement, “This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over.”

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 United States this year.

Dr. Richard Reed, a Terre Haute family practice physician, said the issue “has been a controversy for a while now.”

Some medical groups recommend starting annual mammograms at 40, and others recommend starting them at 50.

Reed said his approach with his patients has been “in the middle.” If a woman has any kind of family history of breast cancer, he has them start annual mammograms at 40. For all other women, he recommends they start annual mammograms at 50.

With the latest U.S. Preventive Services Task Force guidelines, he may revise his advice to his patients and recommend mammograms every two years for women once they reach 50, unless there is a history of prior problems.

The task force takes an objective look at the research and tries to decide the benefits versus the risks. “They said we don’t have enough evidence to support routine mammograms at age 40,” Reed said.

The U.S. Preventive Services Task Force “is pretty well respected” in the medical field, he said.

Gwen Hicks, board president and founder of Susan G. Komen for the Cure-Wabash Valley Affiliate, believes the new recommendations have caught many women by surprise.

She knows many women under age 50, and some under age 40, who have detected breast cancer through self exams.

In her mind, recommendations that discourage self exams and suggest waiting until age 50 for routine mammograms every two years are “not good advice.”

Hicks believes “this will be a hotly-debated issue for awhile.”



Sue Loughlin can be reached at (812) 231-4235 or sue.loughlin@tribstar.com.

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