Mammogram recommendations don’t sit well with doctors, women

January 19, 2010

By David Hayes

When the U.S. Preventive Services Task Force made new recommendations for breast cancer screening in November, Susan Woerdehoff said she was shocked.

“I thought it was ridiculous,” said Woerdehoff, 43, who was diagnosed with stage 1 breast cancer at age 38. “I didn’t necessarily understand it. But it was concerning. It didn’t seem to benefit the greater good.”

What the Bellevue resident said she didn’t understand was the recommendation to move away from years of standard practice.

The federally appointed task force recommended that women at average risk should wait to get routine screening mammograms until they’re age 50, instead of the current standard of 40.

It also advised that women ages 50 – 74 get them every two years and discourages doctors from advising women to examine their own breasts regularly.

The guidelines seek to reduce overtreatment. Downsides to screening include false-positives, radiation exposure and psychological harm, according to the task force report.The recommendation for new standards didn’t sit well with many doctors, including Dr. Patricia Dawson, medical director and breast cancer program leader at Swedish Medical Center.

“I found the recommendation disturbing,” she said. “All the studies on mammographies have pretty well shown the benefit of screening women. The analysis is complicated.”

For example, Woerdehoff, who is being treated by Dawson, has a family history of cancer — her mother is a breast cancer survivor and two aunts had ovarian cancer. So, she was advised to begin annual mammographies and self-examinations before her 40s.

In her 20s, she found weird lumps that were just cysts. Cancer was finally found through an annual mammogram.

“Without that mammogram, I wouldn’t have found it at all or too late,” Woerdehoff said. “When it was found, it was stage one. It could have been much worse.”

Because so many women catch the early signs in their 40s, many medical groups, including the American Cancer Society and American College of Obstetricians and Gynecologists, are recommending sticking with the old standard.

Even though the task force’s new guidelines are nonbinding, Dawson said she worries some insurance companies could choose to use them, thus narrowing the number of mammographies covered.

Breast cancer remains the most common form of cancer for women and the second leading cause of death in women, she said.

“Bottom line, is it’s more survivable through early detection,” she said.

Regardless of which guideline patients follow, Dawson said women should definitely discuss their personal situation with their care provider.

“My suggestion,” Woerdehoff added, “is to be proactive. Be mindful of your own situation and take responsibility for your own health.”

David Hayes: dhayes@isspress.com, 392-6434, ext. 237. Comment at www.issaquahpress.com.

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