Mammogram recommendations for breast cancer change: politics or good science?

The new recommendations for breast cancer screening call for no mammograms until the age of 50.

According to the Press Democrat, the new guidelines are being reacted to with a mixture of skepticism, anger, and concern. Outrage is the emotion mentioned by Dr. Harry Phillips, a radiologist, whose practice may suffer if the guidelines are implemented.

The panel also recommended that women over 50 be screened only every two years, that no routine screenings be given to women over 74 and that breast self-examinations should no longer be encouraged or taught because it leads fearful women to seek out tests that prove unnecessary.

Nancy Bellen, a breast cancer survivor and activist in Santa Rosa who was diagnosed during a pregnancy test when she was 32, said she knows mammography is less effective on younger women, whose breasts are more dense. But without anything better to replace it, she fears younger women will be overlooked.

There is the AMAS test, which was developed by a nurse and uses a plastic syringe to extract a small amount of breast fluid and doesn't have the dangers of ionizing radiation or pain of mammograms, but few health care practitioners may be recommending it.

An article in the Washington Post claims the reactions to the new guidelines are politically driven. Even congress has promised to conduct hearings, and although the mammogram guidelines are only recommendations, powerful economic forces may be at work.

Many patient advocacy groups and breast cancer experts praised the decision, arguing that politics have too often interfered with science when it comes to mammograms. Maryann Napoli, associate director of the Center for Medical Consumers, said breast cancer screening is frequently "used by politicians as a way to say they are for women," whether or not the underlying policy makes sense.

An article in NaturalNews claims the announcement from the panel led to a very vocal backlash from cancer industry promoters and even a few deeply misinformed celebrities like Sheryl Crow who swear by mammograms, but may not have a good understanding of the effects of ionizing radiation. He raises questions about the possible sexist qualities of mammograms and preventive mastectomies, among other issues.

Despite the reactions pro and con to the recommendations,fewer women are getting mammograms already. A CDC study that analyzed five years of telephone surveys found that the percentage of respondents who had gotten a mammogram in the preceding two years dropped from 76.4 percent in 2000 to 74.6 percent in 2005. Those numbers would translate to 1.1 million fewer women nationwide getting routine screening, says Jacqueline Miller, medical director of the national breast and cervical cancer early detection program at the CDC.

 Why are women getting fewer mammograms? For one thing, there are continuing questions about whether a positive mammogram, particularly for women in their 40s, is more likely to save a woman's life by having treatment started promptly or to expose her to lengthy, harsh treatments that might not have been necessary. That's because not all tumors eventually cause disease. Cost, pain from mammograms, and inconvenience may also factor in.

 Where do you stand in this debate? Are you on the side of science, politics, economics, or some other side?

photo: Visualsonline.cancer.gov