No, the resistance to the new guidelines by the industry has to do with profits. I had a 40 yr old base line and it was destroyed by the time I was 50.

” I had a baseline mammogram at 40 at the suggestion of my doctor. I continued every other year until my 50th birthday when a shadow was found on my right breast. I was diagnosed twice in my right breast with D.C.I.S. (2000 and again in 2004).”

Most DCIS should not be treated by more than lifestyle changes.

” I believe early detection saved my life.”
research does not support this assumption, propaganda of course will.
Fact is, all that mamography may have caused the DCIS, and treatment is more likely to have shortened your life.

Cancer treatment is very profitable. Many teaching facilities pay bounties for breast surgical patients so they can teach surgery, reconstruction, implants (very profitable field without cancer) to medical students.

Patients are not told the truth about surgery and how it stimulates cancer growth. Women are encouraged to undergo multiple reconstruction surgeries.

the best thing we could do for our breast health is to limit cancer casing medical care from xrays to mammography

outlaw the use of hormones and other cancer related agricultural practices

change our diets and lifestyle, stress, activity level, food and drink

With all the women diagnosed with breast cancer, and the lack of progress in treatment, we need to look more at causes, and alternative treatments/prevention.

I also have had surgery, but I am convinced it shortened, not “saved my life.”

Telling personal stories is an important way to give and get peer support. And, our personal stories are effective tools for motivating legislators to take seriously our health issues and invest money in researching our diseases. Personal stories, however, are not a substitute for science, and should have no bearing on the recommendations given by a scientific task force.

Had the task force sat on this research and not acted on it through creating revised guidelines, the same women who are outraged now would be doubly outraged for not being taken seriously as a patient population. Kudos to these brave scientists who in the process of doing their jobs have been wedged in a cultural battle that has little relevance to what happens in the analytic world of cancer research. If we want science to lead the way towards reduced cancer mortality rates, we need to be willing to accept evidence-based truths, even when they are contrary to our current habits.

Keep up the great reporting!

Kairol Rosenthal
http://everythingchangesbook.com/

For anyone wanting to read an excellent take on the subject of mammography (from a doctor’s perspective), see link here: http://preventcancer.com/patients/mammography/ijhs_mammography.htm

I remember when the medical community was advocating for women to get a baseline mammo at 35…I can’t remember any outcry when they pushed it back to 40.

Keep in mind that the rest of the worldwide medical community (of experts) suggests that women get mammograms beginning at age 50. So it’s time we got on board with the rest of the experts!

Mammograms help in a very specific case – cancers that are going to spread by the time one can see a tumor, but the mammogram detects them before this time. Now, nobody can say in which of these groups your mother’s cancer would be. But this is why the researchers need real data such as mortality reduction rather than individual stories. Every survivor would like to think her life was saved; otherwise, her suffering would’ve been for nothing. But this is not what data shows.

According to Cochrane review, for every woman whose life is saved, 10 women are converted into cancer patients unnecessarily. Cochrane is completely independent – they have no special interests: no profit from mammograms and no profit from money saved on mammograms.

Treatment for cancer has real risks. Tamoxifen for example may result in a stroke. Surgery has risks, radiation may cause heart problems later even another cancer. When you screen a lot of women, many women get diagnosed with cancer that would never have spread, some of them may die as the result of treatment or suffer life long side effects. Yes, if the treatment saved your life it may be worth it, but what if you could’ve lived your full life without ever knowing you had cancer and instead you suffer life long side effects from treatment or worse die from it? Is unnecessary heart damage from radiation in one woman worth another woman’s life saved from cancer? What about 10 women who suffer side effects from unnecessary treatment vs one woman’s life saved?

In terms of false positives – 10% number probably refers to number of biopsies. At least in the US the cumulative probability of at least one false positive after 10 years of screening is close to 50%. Now, you may ignore “anxiety” as a non-issue, but in some women it causes real problems like high blood pressure. Keep in mind that mammogram studies only looked at reduction in breast cancer mortality. Nobody has ever shown a reduction in all cause mortality. So if some women get heart disease as a result from some cancer scares, statistics wouldn’t show it.

Also don’t forget radiation. It’s small but it adds up, especially in younger women. Is some woman getting cancer from it, worth some other woman’s life saved?

Incidentally, there is nothing new in USPSTF decision. Those of us who were interested in the subject have known about the controversy for a long time. The only difference now is more data about the extent of overdiagnosis.

One other thing. Looking at the time one survives after diagnosis is very misleading. This is affected by what is called “lead-time bias”: a woman dies at the age of 50 from breast cancer; if her cancer is diagnosed early at 43, she survives for 7 years; if late at 48 – only for 2 years, but you wouldn’t say early detection helped her. The only important data when it comes to screening is reduction in mortality from screened vs non-screened population. And these numbers are awfully small.

Disclosure: I am not a doctor or epidemiologist, just a woman with personal interest in epidemiology and who followed the discussion, the studies and controversy of mammograms for a while. I also looked at the data about 5 years ago and decided I don’t want mammograms. Not while I am in my 40s, and maybe not even later.

I think what bothers me the most is not what the investigators’ INTENTIONS were (and I do believe they were thoughtful and well-meaning), but what the consequences could be. 1. Some women might think that breast cancer won’t be a risk until they turn 50 2. A delay in diagnosis (even if the woman’s survival isn’t decreased), from a cost standpoint, might result in a greater need for more expensive treatments such as more radical surgery drug therapies 3. Women in their 40s, as a subgroup, may not be able to obtain a mammogram deemed necessary by a specialist because insurance won’t pay for it.

The problem is that mammograms remain the state-of-the-art. It seems inappropriate to be looking at them retrospectively when we have not yet ushered in the new tool that will improve diagnosis. Some people have been blaming hard-line doctors as too eager to utilize mammography; perhaps…but they are doctors not medical device manufacturers and they can only use what they have. My personal opinion is that since the analysis, despite mammography’s many downsides, admitted to improved survival with its use and that bc death rates may increase slightly if the new guidelines are followed, we shouldn’t be so hasty in abandoning it.

The recommendations may have been easier to understand if they stated something more in line with the reasoning they are using to actually change them. For example: How about a baseline at 42, and then mammograms every 4 years until age 50? Then biennial? Ultimately, yes, it will be up to a woman and her Dr. to decide, but standards eventually dictate what is and isn’t covered by our insurance. Many women just like me (with no family history and no risk factors) would not get tested until it was too late or far more costly to treat.

My point here is that the recommendations changed so drastically, we cannot rationally understand it. I’ve read the research, and the findings are not that drastically different than 2002, in fact, many of the studies are from before 2002! The evidence is just not that compelling to warrant this huge change.

Breast cancer is more than one disease. There are different types of breast cancer and not all of them require the same treatment. It is not clear that we are making any difference by treating breast cancer diagnosed between 40-49. Those cancers that are not aggressive were never going to spread so we don’t really cure them. Those cancers that are aggressive appear to spread despite the standard treatment.

People often insist that it is worth any amount of money to save one life, but that’s not really what we believe. If we were to lower the speed limit on highways to 35 mph, we could save thousands, maybe tens of thousands of lives, yet we don’t do it. Why? Because it is too inconvenient, and costs too much time.

When it comes to making guidelines for large populations, the lines we draw are always somewhat arbitrary. Though people claim to be outraged at dropping the recommendation for yearly mammograms in women aged 40-49, why aren’t they clamoring that the recommendations should be extended to yearly mammograms for women aged 30-39? If they truly believed, as they claim that they do, that it is worth any amount of money to save one life, they should be insisting on screening for women aged 30-39 since breast cancer can occur in that group, too.

There’s nothing special about whole numbers that end in 0. Why not recommend yearly screening women aged 28-39? For that matter, there’s nothing special about yearly intervals. Why aren’t they recommending screening for all women every 6 months instead of every 12 months? Surely we could save a few more lives that way, too.

The fact is that we are forced to make relatively arbitrary policy decisions when it comes to safety issues of any kind. We are always forced to balance benefits and costs. We don’t really believe that it is worth any amount of money to save even one life. We don’t even believe that it is worth getting to our destination a little later to save thousands of lives lost on the highway each year.

That’s why the outrage over rationing is entirely misplaced. If by rationing people mean considering cost when making safety decisions, we ration every day in many ways. We live in the real world, and in the real world there is not unlimited money. A dollar spent on mammograms is a dollar not spent on another form of healthcare that may have a much better benefit to cost ratio. It is not rationing to suggest that some money spent on mammograms might be better spent elsewhere. It is merely common sense.