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Breast cancer and the bean counters
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The Preventative Task Force panel, a group of physicians reporting to the federal government, have once again switched their position on screening mammography for breast cancer. Their new guideline recommendations are for women not to undergo mammography screening until they are fifty years of age, and only every other year at that. They also argue against the principle of breast self-exams, citing no significant improvement in survival with earlier mammograms and self-exams.
Their argument for these new guidelines are as follows: breast cancer risk increases after age fifty, and earlier and more frequent mammograms result in an increase in unnecessary surgical biopsies that may harm the woman. In deciding this, the panel invokes the risk versus the benefit of screening mammograms for the general public. Others have argued that funds should be directed towards breast cancer research and that some tumors never progress to the point of harming the woman.
The American Cancer Society and the College of Radiologists strongly disagree. Breast cancer is progressivley affecting younger women, and tends to be more aggressive in young and in Black women. Breast biopsy proceedures nowdays involve more accurate and minimally invasive surgery; this consists of stereotactic needle biopsies that require only a very small incision in the skin under anesthesia. Earlier breast cancers are being found by more refined radiologic and biopsy techniques, and we have yet to define which breast cancers will progress to endanger the woman's life and which will not. Indeed, some breast cancers advance rapidly within a year and would possibly be missed on every other year mammograms. Lastly, what woman will wait ten to twenty years for results of cancer research?
We know that women at increased risk for breast cancer include women with a family history of breast cancer in a close relative under the age of 45 at the time of diagnosis, women with early onset of menses and those with certain breast, or BRAC, cancer genes. These women benefit from a "baseline"
mammogram earlier in life and more frequent exams thereafter. Fifty percent of breast cancers are found on mammogram alone, and a significant number are found on self-exam.
The federal government-sponsored bean counters have taken select statistics to develop general, public guidelines based on what appears cost effective, not what may affect the safety and best standards for an individual woman. Their conclusions also send a strong signal to the insurance companies not to pay for mammograms more often than every other year. We find these guidelines confusing and misleading at best, and at worst, disallow a subgroup of women at high risk for developing breast cancer the screening studies necessary for diagnosing early cancer, thus saving lives.
The Jackson area is blessed with a number of cancer surgeons and radiologists dedicated specifically to the diagnosis and treatment of breast diseases, from the University Center through the major hospitals and on to individual clinics. Ultimately, the decisions for breast cancer should remain with the individual woman and her physician, not on task force recommendations focused on cost containment.
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