Live Debate: Breast cancer screening and mammography

By Reuters Staff
November 16, 2009

cancerSweeping new U.S. breast cancer guidelines released on Monday recommend against routine mammograms for women in their 40s, and suggest women 50 to 74 only get a mammogram every other year.

The new guidelines by the U.S. Preventive Services Task Force, an influential panel of independent experts, would sharply curtail the number of breast mammograms done in the United States, sparing women the worry of false alarms and the cost and trouble of extra tests.

But U.S. cancer experts say the altered schedule may mean more women will die from breast cancer.

Should you and your loved ones get mammograms? What are the implications for health care reform, with members of Congress looking for ways to cut costs?

Join us for a live online on breast cancer screening and mammograms on Tuesday, Nov. 17, at 12pm ET. The event will be moderated by Reuters Health Executive Editor Ivan Oransky and joined by Reuters’ editor in charge of health and science, Maggie Fox.

Our confirmed participants:

Heidi Nelson, research professor of medical informatics and clinical epidemiology and medicine at the Oregon Health Sciences University, who has led systematic evidence reviews for the U.S. Preventive Services Task Force.
Daniel B. Kopans, professor of radiology at Harvard Medical School and director of breast imaging at the Massachusetts General Hospital.

You’ll be able to follow the discussion by listening in on the conference call line below or via the live blog here (it’s also embedded lower on this page.) If you have any questions for the participants, please leave them in the comments below. We’ll ask a selection on your behalf.

Update: Thanks to everyone who participated. You can hear a recording of the call here

International direct dial-in number

+1 857 350.1676

US Dial-in number

1 866 788.0538

Passcode:

545 963 95

14 comments

We welcome comments that advance the story through relevant opinion, anecdotes, links and data. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links. Views expressed in the comments do not represent those of Reuters. For more information on our comment policy, see http://blogs.reuters.com/fulldisclosure/2010/09/27/toward-a-more-thoughtful-conversation-on-stories/

I am a 42 year old woman who just finished chemo and is about to start radiation. There is no history of breast cancer in my family and negative tested in the BRAC gene test. If the mamorgams get changed to 50 I would have been a dead woman with my aggressive breast cancer. Under 50 and it is usually aggressive. This needs to be covered. Protect the women in your life.

Posted by michele cohen | Report as abusive

ONLY the beginning of rationing of health care.

Posted by Susan Schultz | Report as abusive

I am troubled by the science behind the lower level of mammograms being recommended now. Most breast cancers seem to be encouraged by the level of estrogen in womens’ bodies. This was confirmed by discovery that estrogen (hormone) replacement “therapy” increases breast cancer risk.

But from age 50, most women are approaching menopause when presumably their bodies’ estrogen production is falling.

So why is it just then, when they are menopausal, that they are presumed to be at the greatest risk of breast cancer? Until that question has been answered satisfactorily by analysis of how breast cancer starts, I think it is dangerous to stop mammograms being taken annually from an earlier age.

vivian lewis

Posted by vivian lewis | Report as abusive

Just another attempt by HMOs and PPOs at saving a buck no matter how many it kills. Geesh, this proves those bastards CEOs don’t have mothers, they decended from wolves.

Posted by Hal | Report as abusive

False alarms are not the only harm from mammograms. Please discuss the issue of overdiagnosis and overtreatment.

Posted by Christie | Report as abusive

I was told last year, when I started Medicare, that they would only pay for mammograms every other year! The rationing of heathcare began before this new announcement, so they have to follow now with their recommendation.

Great — instead of being diagnosed with Stage 2 breast cancer at age 44, I could have waited until I was 50 and had Stage 3 or 4. I would have been far less assured of survival, and my treatment have cost “the system” more.

More and more women are being diagnosed with breast cancer at an earlier age — the cancer center was full of women younger than me, and yes, 44 is still considered young for cancer. There is NO history of breast cancer in my family.

And you think we shouldn’t worry about death panels.

In lieu of the government putting in place REAL health care reform, like health savings accounts, I will be setting aside a certain portion of savings so that I can get the tests and care that I and my doctor deem necessary!

Posted by Joanne | Report as abusive

The task force has it backwards: women have mammograms done so that they WON’T worry.
According to the CDC, in 2005 there were 186,467 women and 1,764 men who were diagnosed with breast cancer. That same year 41,116 women and 375 men died from breast cancer (http://www.cdc.gov/cancer/breast/statis tics/index.htm)
Does the task force really claim that not recommending mammograms for women in their 40′s is a benefit because it “spar[es] women the worry of false alarms and the cost and trouble of extra tests”? Isn’t the the consequence of breast cancer greater than the “cost,” “trouble” (a couple of hours a year), or “worry” of having this preventative test done? Isn’t it cheaper to find a disease and treat it BEFORE it becomes serious? A false positive is a small price to pay. I would rather have a false positive than not know that I had breast cancer. A test isn’t “extra” when it confirms good health or sickness. Breast cancer is a deadly disease. A woman who is cleared of it has less worry (one of the supposed “goals” of the task force) while the woman who discovers she has breast cancer has a chance to fight it.
What “cost” is the task force talking about? Surely it isn’t concern for OUR wallets. Women who get a mammogram apparently don’t mind the cost, trouble, or worry of having the exam, or they wouldn’t have it in the first place. What the task force really means is that the insurance companies will be saving buckets of money. If government guidelines don’t recommend having a mammogram before age 50, then insurance companies will stop paying for any mammograms for women under age 50. So while the insurance companies save money, women who can’t get mammograms worry that they might have cancer. I bet they wouldn’t mind being “troubled” by having a mammogram more often. If a woman finds having a mammogram to be too burdensome, then she probably doesn’t have one done or has one done less frequently. For her, the “cost” and “trouble” of a mammogram, and “worry” of a false alarm, are nonexistent. For those who do have one done, the cost, trouble, and worry of a false alarm are clearly a price they are willing to pay.
So who is supposed to benefit from the new guidelines? Insurance companies. Women certainly aren’t benefited by having fewer exams.
Instead of being screened EVERY year, this task force also “predicted that screening women 50 to 69 every other year will catch nearly as many breast cancers — 81 percent — while producing half as many false positive results.” So 4 out of 5 is almost as good as 5 out of 5? It might sound rational in such small numbers, but every year tens of thousands of women are diagnosed with breast cancer (more than 186,000 in 2005). So what of the remaining 1 of 5 whose cancer could have been caught earlier? How many thousands of women does the 1 in 5 represent? I bet they were grateful to be spared the “cost,” “trouble,” and “worry” of a false alarm by not having a mammogram sooner. Talk about spin!

Posted by Kirsten | Report as abusive

The new guidelines are not about saving money. The guidelines point out how poor of a screen mammograms are.

2000 women have to be screened with mammograms in order to prolong the life of one woman by diagnosing a breast cancer on screening mammogram. By screening these women however an additional 10 women will be diagnosed with breast cancer and treated unnecessarily for breast cancer. http://www.cochrane.org/reviews/en/ab001 877.html

It’s not just false alarms, it’s being told you have breast cancer when you don’t that is the problem.

There are about 21 million US women between the ages of 40 and 50. IF they are all screened annually for 10 years then 10,000 lives will be saved. However, 105,000 women will be treated for breast cancer needlessly. Why not get outraged about them?!

Another way to look at it, those 100+ thousand women would have lived their whole lives without having a single sign or symptom of breast cancer.

Posted by Judith Harvey MD | Report as abusive

There are so many anecdotal comments on these stories all over the net, but we need to TAKE ACTION.

If you think this is reprehensible, if you doubt the new research, and if you believe that the timing is incriminating, call these people and express your opinion.

Dr. Ned Calonge, Colorado Department of Public Health, Director of the US Preventive Services Task Force, telephone (303) 692 2011

Dr. Diana Petitti, Deputy Director of USPSTF (301) 427 1364

Dr. Jeanne Mandelblatt, Georgetown University Medical Research (202) 687 0812

Secretary HHS, Kathleen Sebelius (202) 205 5445

White House comment line 202 456 1111

If you go online to the USPSTF website, pick a name from the list of task force members and help us research whether any are insurance-linked.

thank you

Posted by Joanne | Report as abusive

This is obviously a potentially volatile issue. The terms overdiagnosis and overtreatment, as I inderstand them, are concerns to be no less lightly taken than the spectre of cancer itself. I agree with their having been cited here and have no desire to offend anyone who feels otherwise on this topic. And yet…

Personally, I have tried, but cannot imagine anyone coming up with the idea that it might be a good thing to take otherwise fine breasts and crush them between mechanical plates while shooting through them with radioactive beams, then to delve deeper into them and the lives of their owners with toxic chemical and other crude tools. I cannot imagine anyone seeing this as a legitimate step toward healing anything. Nor can I imagine any good doctor subscribing to this as though it were the best diagnostic methodology that modern Medical Science could possibly have to offer.

Personally, I have known more people who were killed by intrusive cancer “diagnoses” and “treatments” than have been healed by them.

Ritualized heavy-handedness and arrogance, driven more by fear than by understanding of what might otherwise result, strike me as indicative of the way the Cancer Industry works, to the extent that it may be said to work at all.

That having been said, there is no doubt that such a thing as cancer exists, and that treating it – better yet, fully comprehending and eventually eliminating its origins – is a truly desirable objective. In my opinion, however, there have to be better ways of achieving this goal than through almost obligatory mammography as it is currently practised.

Posted by The Bell | Report as abusive

I Was diagnosed at age 42 with aggressive breast cancer. I have no history of breast cancer in my family. Because of this I was put on a waiting list for a mamorgram. My Doctor could not find the lump I said I felt and that my arm pits hurt because of my bra. She had just compared me to another patient with this problem. This process took 9 months for me to get the correct care (a simple mamorgram). I now have 2 mesectomys and I did aggressive chemo for 6+ months as well as several reconstructions to make something to put in a bra now. If they take the right away for us to ask for a mamorgram because of costs then alot of our children will be motherless.

Posted by susan Davison | Report as abusive

I thought we would only have rationing of care if we had a public payer for health care. Perhaps insurance companies and the government are tired of providing health care for the sick. After all what profit is there in that?

Posted by Anubis | Report as abusive

Breast cancer is huge but aids is the realy big problem. Maybe because it hits closer to home and not in some third world country.

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Posted by jillbradlie | Report as abusive