Eh, women's breast health....who cares? Not the US Government that's for damn sure!

[AquarianPath]

 

Mammograms Starting at 50. What?

 

I don't get the new guidelines issued by the US Preventive Services Task Force (USPSTF) that have been in the headlines these last two days.

According to the website of the USPSTF, here is what they found when looking at lots of data on breast cancer screening:

"There is convincing evidence that screening with film mammography reduces breast cancer mortality, with a greater absolute reduction for women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is among women aged 60 to 69 years. Among women 75 years or older, evidence of benefits of mammography is lacking. Adequate evidence suggests that teaching BSE [Breast Self-Examination] does not reduce breast cancer mortality. The evidence for additional effects of CBE [Clinical Breast Examination] beyond mammography on breast cancer mortality is inadequate. The evidence for benefits of digital mammography and MRI of the breast, as a substitute for film mammography, is also lacking."

 

Perhaps if there were OTHER options for preventive screening other than mammograms or self-breast exams, then it would make sense to tell people to wait until 50 for the former and to stop the latter all together. But it doesn't appear that there other options - even digital mammography and MRI is inconclusive. What is supposed to take their place?

There is so much about this that bothers me, but let me address one thing. The USPSTF concluded that the HARMS of doing mammography between the ages of 40 and 49 were greater than all the instances where mammography detected cancer that wasn't found any other way. Here is exactly what their website says:

"The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results . Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman's lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman's life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.

Adequate evidence suggests that the overall harms associated with mammography are moderate for every age group considered , although the main components of the harms shift over time. Although false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups .

There is adequate evidence that teaching BSE is associated with harms that are at least small. There is inadequate evidence concerning harms of CBE."

WHAT does this mean? I find this part particularly insulting as a woman. Psychological harms - where is there quantifiable data on this? How can they put that on the same level as actual numbers of women who detect cancer via mammograms or BSE or, at worst, those who die because their detection was too late or not at all? What the hell is psychological harm? Are they seriously telling me that dealing with false positives and "unnecessary" bioposies is more detrimental to women than the cancer that could be growing in their breasts but go undetected? This is what it says about CBEs: "The potential harms of CBE are thought to be small but include false-positive test results, which lead to anxiety and breast cancer worry, as well as repeated visits and unwarranted imaging and biopsies." Are ANXIETY and WORRY supposed to go away once women are no longer getting mammograms or doing SBEs?

And here are the parts that boggle my mind.

 

 

Under "Burdens of Disease", it states, "Breast cancer is the most frequently diagnosed cancer in women in the United States, not including skin cancer, and is second only to lung cancer as a cause of cancer deaths. In 2008, an estimated 182,460 cases of invasive cancer and 67,770 cases of in situ breast cancer were diagnosed and 40,480 breast cancer deaths occurred. The National Cancer Institute, on the basis of Surveillance Epidemiology and End Result data, estimates the lifetime risk for a woman to develop breast cancer at 12%. The risk for breast cancer increases with age. The 10-year risk for breast cancer is 1 in 69 for a woman at age 40 years, 1 in 42 at age 50 years, and 1 in 29 at age 60 years ." 1 in 69! That's not high enough to overcome the so-called psychological effects or the chances of overdiagnosis?

Under "Effectiveness of Early Detection," it states, "The newly updated meta-analysis by Nelson and colleagues confirms an earlier finding that screening mammography reduces mortality . Improvements in the relative risk (RR) for death due to breast cancer for women aged 39 to 49 years and 50 to 59 years are similar at 0.85 (95% CI, 0.75 to 0.96) and 0.86 (CI, 0.75 to 0.99), respectively. An even greater improvement was found for women aged 60 to 69 years (RR, 0.68 [CI, 0.54 to 0.87])."

Under "Potential Harms of Screening, Mammography", it states, "False-positive results are common with mammography and can cause anxiety and lead to additional imaging studies and invasive procedures (such as biopsy or fine-needle aspiration). False-positive results and accompanying additional imaging studies are more common in younger women . Biopsies may occur as a consequence of false-positive mammography results; biopsy rates are more common among older women. Anxiety, distress, and other psychosocial effects can exist with abnormal mammography results but fortunately are usually transient , and some research suggests that these effects are not a barrier to screening . False-negative results occur at a relatively low rate for all ages , but are slightly higher in women older than 70 years. Other potential harms, such as pain caused by the procedure, exist but are thought to have little effect on mammography use. Overdiagnosis can occur when screening detects early-stage invasive breast cancer or DCIS in a woman, typically older, who is likely to die from another cause before the breast cancer would be clinically detected. Overdiagnosis can also occur in younger women if a detected DCIS or other early-stage lesion never progresses to invasive cancer. Methods for estimating overdiagnosis at a population level are not well established, and thus the proportion of all detected DCIS lesions that constitute overdiagnosis is uncertain . Similarly, unnecessary earlier treatment can occur at any age when screening detects a slower-growing cancer that would have eventually become clinically apparent but would never have caused death. Radiation exposure may increase the risk for breast cancer, but usually only at much higher doses than those used in mammography, although regular mammography could contribute to cumulative radiation doses from additional imaging for other reasons."

Under "Estimate of Magnitude of Net Benefit," it states, "In 2002, the USPSTF concluded that there was fair evidence that mammography screening every 12 to 33 months could significantly reduce breast cancer mortality. The evidence was strongest for women aged 50 to 69 years, with weaker evidence supporting mammography screening for women aged 40 to 49 years. Since that recommendation, 1 new trial and updated data from an older study have been published that specifically address screening in women in the younger age group. These findings were combined in an updated meta-analysis, which resulted in an RR for breast cancer death of 0.85 (CI, 0.75 to 0.96; 8 trials) and a number needed to invite for screening of 1904 (CI, 929 to 6378) to prevent 1 breast cancer death in women aged 39 to 49 years. A meta-analysis of 6 trials among women aged 50 to 59 years and 2 trials among women aged 60 to 69 years provided pooled RRs for breast cancer death in the screened group of 0.86 (CI, 0.75 to 0.99; number needed to invite, 1339 [CI, 322 to 7455]) and 0.68 (CI, 0.54 to 0.87; number needed to invite, 377 [CI, 230 to 1050]), respectively." AND "The USPSTF noted with moderate certainty that the net benefits of screening mammography in women aged 50 to 74 years were at least moderate, and that the greatest benefits were seen in women aged 60 to 69 years. For women aged 40 to 49 years, the USPSTF had moderate certainty that the net benefits were small . "

Some websites to look at:
American Cancer Society's Response (against the new guidelines): "The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions."

MD Anderson's Response (against the new guidelines): "If you're of average risk, M. D. Anderson recommends you get your first mammogram at age 40 and return every year after that for regular screenings. If you aren't sure how to assess your risk, we recommend setting up time with your physician. "We believe the benefits of an annual mammogram outweigh the risks for women, starting at age 40," says Therese Bevers, M.D., professor and director of M. D. Anderson's Cancer Prevention Center. M. D. Anderson has studied the effectiveness of breast cancer screening and M. D. Anderson faculty contributed to the modeling analyses used by the Preventive Services Task Force to make its recommendation. "

Letter from Donna , the inspiration for the National Marathon to Finish Breast Cancer (she is against the new guidelines)

Dr. Susan Love's Blog (she is all for the new guidelines). According to US News and World Report , she said, "While studies show that breast cancer deaths can be reduced by 15 percent in women who have mammography screening in their 40s, the absolute number of deaths actually prevented, she says, is so small as to be greatly outweighed by the detriments of screening. About 1 in 10 younger women have false findings that turn out not to be cancer, causing needless worry, additional imaging, and unnecessary biopsies; some of the cancers diagnosed aren't life-threatening and might actually vanish on their own without treatment; younger women may be falsely reassured when a mammogram can't spot a tumor that's hidden by premenopausal breast tissue, which t ends to be dense." I don't know what bioposies are really "unnecessary." I mean, you have to have it to whether the lump in your body is cancer. Either result, is anyone really upset that they did the biopsy? If so, I would like to hear that story to understand that perspective better.

NPR's All Things Considered report on this from yesterday, 11/16

Kathleen Reardon's take , titled "I'd Be Dead By Now"

According to FoxNews, Republican Rep. Phil Gingrey of GA,said "that he and other lawmakers are gravely concerned that insurance companies will seize upon the new guidelines to deny mammogram coverage for women under 50." It also reports that Dr. Cynara Commer, a professor of surgery at Mt. Sinai's Surgical Oncology Department in New York "said she is very concerned that the new guidelines are the top of a slippery slope toward rationing, and questioned the timing as the Senate is about to vote on health care reforms that could end up containing a so-called public option. "The government-run insurance companies are definitely going to be using these federal guidelines as opposed to using the American Cancer Society guidelines, and the American Cancer Society is not going along with these guidelines, and we can only hope that the private insurance companies don't follow suit," she said." I think it's fair to argue that whether we ever have government-run insurance companies, we should all be afraid that our good old, for-profit private insurance companies are already working on denying 40-year-old women the mammograms that they want and some will need.

Article in the Chicago Tribune that shows how the recommendations from the USPSTF compare to those of the American Cancer Society for different types of cancer.

From Woman's Day 's website, which includes a link to a recent interview with Dr. Love.
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PLEASE vote popular so more women can be aware of this crap and so we can get on the ball and letting them know how this will NOT be tolerated!!!!

[MemawBrie]

Nov. 17, 2009 at 7:28 PM

Like I said, welcome to Obamacare.  Things will only get worse with the government in charge of our health-care.

[Jambo4]

Nov. 19, 2009 at 11:34 PM

Brie has it right... they are just preppin us for Gov run health care.  When the Gov is footing the bill, then "useless" and costly things like this are gonna go right out the window.

bottom line ladies.. that's what it's all about.