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Gingersnap
11-17-2009, 11:49 AM
Breast exam guidelines now call for less testing

Change debated
Potential harm of frequent mammograms outweighs benefit, task force says

By Rob Stein
Washington Post Staff Writer
Tuesday, November 17, 2009

Women in their 40s should stop routinely having annual mammograms and older women should cut back to one scheduled exam every other year, an influential federal task force has concluded, challenging the use of one of the most common medical tests.

In its first reevaluation of breast cancer screening since 2002, the independent government-appointed panel recommended the changes, citing evidence that the potential harm to women having annual exams beginning at age 40 outweighs the benefit.

Coming amid a highly charged national debate over health-care reform and simmering suspicions about the possibility of rationing medical services, the recommendations immediately became enveloped in controversy.

"We're not saying women shouldn't get screened. Screening does saves lives," said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday's Annals of Internal Medicine. "But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully."

Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy.

But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

"Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it," said Daniel B. Kopans, a radiology professor at Harvard Medical School. "It's crazy -- unethical, really."

The new guidelines also recommend against teaching women to do regular self-exams and concluded that there is insufficient evidence to recommend that doctors do the exams or to continue routine mammograms beyond age 74.

This will get politicized but it's been under discussion for years. There are really three important issues wrapped up in these new guidelines: noncompliance due to fear, false positives, and new information about the progression of cancers.

All the hoopla about breast cancer and the nearly constant drumbeat to do self-testing and get examined every year has actually started to worsen prevention efforts. Women are getting the idea (the wrong idea) that breast cancer is inevitable so why bother?

The number of false-positives revealed through routine screening is high. Since confirmation can only be done through tissue biopsy, this means a lot of worry, expense, and disfigurement.

Now it appears that not every cancer detected in the breast will behave aggressively. In fact, some very common cancers may develop and then spontaneously resolve over time. This may be dead-on normal. In fact, the older a woman is, the less aggressive these common cancers may be.

Interesting stuff.

WaPo (http://www.washingtonpost.com/wp-dyn/content/article/2009/11/16/AR2009111602822.html?hpid=topnews)

lacarnut
11-17-2009, 11:59 AM
I would have to side with the American Cancer Society that testing saves lives. It saved my mother's. Looks like these idiots in the government want to do less testing so that the death rate of cancer victims will increase to the level of EU cancer rates. Gotta save money; hello, public option.

linda22003
11-17-2009, 12:04 PM
I go half as often as my HMO wants me to (every two years, vs. every year). It's working well.

Gingersnap
11-17-2009, 12:15 PM
I would have to side with the American Cancer Society that testing saves lives. It saved my mother's. Looks like these idiots in the government want to do less testing so that the death rate of cancer victims will increase to the level of EU cancer rates. Gotta save money; hello, public option.

Don't politicize this one, guy. While many women have benefited from early detection and aggressive treatment, more women have suffered the negative effects of needless surgery, chemo, and radiation. Even the testing itself increases a woman's lifetime odds of getting cancer.

These guidelines are about finding the right balance between lifesaving detection and treatment versus patient harm.

Most aggressive breast cancers that develop in women under 50 are found by the women themselves during the course of ordinary grooming - not through breast self exam and not through mammography. ;)

GrumpyOldLady
11-17-2009, 12:25 PM
This is just so that they can save money when Obamacare kicks in.

I've been getting mamograms every year since age 35 or so.

At the risk of being personal ... i'm rather lumpy.

I've had a dozen cysts drained and lumpectomies.

If they cut the guidelines then a cut in paid testing is sure to follow

I think it's bad business.

lacarnut
11-17-2009, 12:43 PM
Don't politicize this one, guy. While many women have benefited from early detection and aggressive treatment, more women have suffered the negative effects of needless surgery, chemo, and radiation. Even the testing itself increases a woman's lifetime odds of getting cancer.

These guidelines are about finding the right balance between lifesaving detection and treatment versus patient harm.

Most aggressive breast cancers that develop in women under 50 are found by the women themselves during the course of ordinary grooming - not through breast self exam and not through mammography. ;)

Since the American Cancer Society and the death rate of cancer is lower in this country than in the EU, I will go with their recommendation.

linda22003
11-17-2009, 12:57 PM
Since the American Cancer Society and the death rate of cancer is lower in this country than in the EU, I will go with their recommendation.

Which you can certainly do! When was your last mammogram?

lacarnut
11-17-2009, 01:12 PM
Which you can certainly do! When was your last mammogram?

The same as your last cranium exam.

linda22003
11-17-2009, 01:22 PM
The same as your last cranium exam.

Oh! So... about three months, then.

lacarnut
11-17-2009, 01:25 PM
Oh! So... about three months, then.

If you are screwed up in the head, that's your problem.

linda22003
11-17-2009, 01:26 PM
No, I had an MRI. I'm absolutely loaded with brains. :p

Gingersnap
11-17-2009, 01:30 PM
Since the American Cancer Society and the death rate of cancer is lower in this country than in the EU, I will go with their recommendation.

It is but we aren't talking about recommending "no screening" instead of excessive screening. We're talking about the middle ground here. It's not very useful to unnerve women to the point where they avoid screening altogether nor to scare them into believing that detection is just the beginning of the end since cancer is inevitable.

The lower death rate we enjoy is partly due to almost instantaneous biopsy of suspect tissue in women under 45 and mostly due to early and aggressive treatment of confirmed cancers. New studies haven't shown that our frequency of mammography or our insistence on self-examination contribute to fewer deaths. ;)

lacarnut
11-17-2009, 02:06 PM
It is but we aren't talking about recommending "no screening" instead of excessive screening. We're talking about the middle ground here. It's not very useful to unnerve women to the point where they avoid screening altogether nor to scare them into believing that detection is just the beginning of the end since cancer is inevitable.

The lower death rate we enjoy is partly due to almost instantaneous biopsy of suspect tissue in women under 45 and mostly due to early and aggressive treatment of confirmed cancers. New studies haven't shown that our frequency of mammography or our insistence on self-examination contribute to fewer deaths. ;)

An independent government funded study makes me go hmmmmmmmmmmmm. With the government hell bent on reducing cost, this study is tainted in my opinion. Color me suspicious of government. Less tests, less care means saving for the government. I for one will not live under a public option system or a HMO plan. Sadly, I think it is coming.

My mom had breast cancer when she was in her 40's. Like I said, I will go with the American Cancer Society's recommendation.

linda22003
11-17-2009, 02:28 PM
Serious question: What's wrong with an HMO? I've been in one for decades and they've taken very good care of me. If anything, they noodge me to come in more often than I want to.

Gingersnap
11-17-2009, 02:36 PM
Serious question: What's wrong with an HMO? I've been in one for decades and they've taken very good care of me. If anything, they noodge me to come in more often than I want to.

I'm with you - I like my HMO even if they are kind of pushy. :)

lacarnut
11-17-2009, 02:46 PM
Serious question: What's wrong with an HMO? I've been in one for decades and they've taken very good care of me. If anything, they noodge me to come in more often than I want to.

My experience has not been good. I had TMJ. I went to 2 Doctors that were too stupid to diagnose the problem. One was an specialist that told me I had arthritis in my jaw. I paid out of pocket for the 3rd one who sent me to a dentist.

I have 2 health policies where I can go to any doctor or any hospital in the US without a referral of any kind. The gold standard insurance is what I want and I am willing to pay for it. If I get cancer, I will go to MD Anderson in Houston. My BIL had a rare form of cancer. Experimental treatment probably saved his life. I want to have that choice to go where I damn well please.

JackKetch
11-17-2009, 03:22 PM
someone i know has breast cancer that has already spread to her liver and bones, probably elsewhere. they're still running tests. she is only 40. the doctors say that this aggressive cancer probably developed and spread within the past 6-12 months.

i've forgotten whether it was mentioned here that mammograms won't be covered by obamacare. neither will pelvic exams. :mad: :mad: :mad:

Gingersnap
11-17-2009, 04:03 PM
someone i know has breast cancer that has already spread to her liver and bones, probably elsewhere. they're still running tests. she is only 40. the doctors say that this aggressive cancer probably developed and spread within the past 6-12 months.

i've forgotten whether it was mentioned here that mammograms won't be covered by obamacare. neither will pelvic exams. :mad: :mad: :mad:

Where did you hear that? I'm no fan of the latest health care bill but as far as I know, it would cover mammography and pelvic exams - these procedures just aren't included in some kind of mandatory female mass screening effort for all ages.

Most women don't need annual pelvic exams and getting them not only annoys a lot of women but medicalizes some conditions that are pretty much normal for a lot of women. Things like uterine fibroids. Pap smears are covered but I assume the bill would take into account the latest research on that test and annual Pap smears wouldn't be required for every woman.

Women who have unusual pain or bleeding would get a pelvic exam just as a woman who had unusual pain or bleeding in her ear would get an ear exam. We don't get ear exams annually because most people don't need them.

There are plenty of bizarre or potentially disturbing elements in this bill already without focusing on women's health fears.