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New health guidelines announced for breast cancer

Local doctors say women should consult with their health care provider

Local doctors say women should consult with their health care provider

November 16, 2009|By ERIN JULIUS

WASHINGTON COUNTY -- Local breast cancer advocates suggest women check with their doctors before making changes in their health routines, despite new guidelines announced Monday indicating most women don't need a mammogram in their 40s and should get one every two years starting at 50.

"It's really important they check with their physician," said Joan Fell, executive director of Breast Cancer Awareness-Cumberland Valley Inc.

The health guidelines changes announced Monday by the U.S. Preventive Services Task Force are a major reversal that conflicts with the American Cancer Society's long-standing position.

But 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.

The guidelines are for the general population, not for those at high risk of breast cancer because of family history or gene mutations that would justify having mammograms sooner or more often.

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The new advice says:

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

o Women ages 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.)

o The value of breast exams by doctors is unknown and breast self-exams are of no value.

The benefits of mammography for women between the ages of 40 and 50 have been controversial for a number of years, said Dr. Frederic Kass III, medical director for the Washington County Health System's John R. Marsh Cancer Center.

Mammograms are less sensitive to possible abnormalities in women in that age group because they have denser breasts, Kass said. Cancer is also less common in that age group, he said.

"Guidelines evolve. One of the things clearly that's part of the message here, and it's not a wrong message, is there is a fixed number of health care dollars," Kass said.

If early mammograms are shown, by good studies, to be not worthwhile, those dollars can be used for mammograms on older women or for younger women at high risk, Kass said.

New methods of screening, including genetic tests, are being developed. Money previously spent on mammograms for younger women might be shifted to other screening methods, Kass said.

However, saying that self-exams are ineffective sends the wrong message, Kass said.

Self-exams are free, get women active in her own health care and often spur them to contact their doctors, he said.

"If we start telling women it doesn't matter what you feel, we will lose early warning signs for breast cancer," he said.

Something a woman finds during a self-exam might lead her to schedule a mammogram. Studies will show the mammogram found cancer, but "how many time does a woman go schedule a mammogram because of an abnormality?" Kass said.

"Numerous women have told me over the years they found the breast cancer themselves," said Fell, adding that she foresees a lot more discussion about the value of self-exams.

"The lady who found the breast cancer herself and is surviving, that's a very important thing for her," Fell said.

Any woman whose physician recommended a mammogram or ultrasound and needs assistance covering the costs should contact Breast Cancer Awareness-Cumberland Valley, Fell said.

"Everything comes down to finding it early," she said.

International guidelines also call for screening to start at age 50; the World Health Organization recommends testing every two years, while Britain suggests every three years.

Breast cancer is the most common form of cancer and the second leading cause of cancer deaths in American women, according to a report by The Associated Press. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year, the AP said.

Mammograms can find cancer early, and two-thirds of women older than 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated, the AP said.

In most women, tumors are slow-growing, and that likelihood increases with age, according to the AP. So there is little risk by extending the time between mammograms, some researchers say.




For more information about breast cancer support available locally, go to Breast Cancer Awareness-Cumberland Valley Inc.'s Web site at www.bcacv.org.

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