When I read the news last week that a government task force had changed its guidelines on routine mammography screening, I did a double take.
For years, I understood clearly that my first mammogram would be in my 40s, or in my case, because of a family history of breast cancer, could be as early as my mid-30s.
Now, the information coming out of the United States Preventive Services Task Force that screening for healthy women with an average risk of breast cancer should begin at age 50, not at 40, and that tests be given every two years instead of every year, turned that notion on its head. Even more confusing was the recommendation that doctors not train women to do self-breast exams.
The thinking behind the guidelines is that the risks posed by early screening outweighed the benefits.
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After my initial disbelief, my next gut reaction was that it was the wrong approach. Wouldn’t it set back years of educating women, many of whom are already skittish about mammograms, to get screened?
And wasn’t the point of screening starting at age 40 to catch breast cancer, which continues to be the second-leading cause of cancer deaths among women, as early as possible?
Dr. Monica Rocco, a breast surgeon with Marian Medical Center’s Cancer Center program in Santa Maria, said the bottom line is that decades of research in the medical community have proved that annual screening for women 40 and older saves lives. Some recent studies, she noted, have shown that screening between the ages of 40 and 70 can reduce mortality by as much as 32 percent.
“We ran the statistics at Marian for the last six years, and 22 percent or greater of our breast cancer cases were women less than 50 years old,” she said. “Are we willing to just ignore 22 percent of the patients?”
One of her patients, Kimberly Nickell, is proof that early detection works.
Nickell, a 42-year-old mother of two, was diagnosed after having her routine mammogram two years ago. There were no lumps or bumps, but the screening caught a tumor about the size of a pea.
She had a previous mammogram in her late 30s but was shocked by the cancer diagnosis in 2007 and had to undergo chemotherapy and now radiation.
But she was just as shocked by the government guidelines, which she believes would turn back the clock on cancer screening.
“Mine was the type that was aggressive,” Nickell said. “We would never have known until it got really big and it would probably be too late.”
Dr. Fred Vernacchia, a diagnostic radiologist in San Luis Obispo, also took issue with the recommendations, saying that they are not only flawed because public health officials relied on outdated film mammography data (today, most are done digitally, which is considered to be a significantly better screening tool) but failed to take into account that women in the age 40 to 49 group often have the most invasive cancers.
As a society, he said, we have made the decision to spend resources to save the lives of “young vibrant women in the middle of the most important times of their lives,’’ he said.
“These people have completely missed the boat,’’ he said.
In recent days, after an outcry from the American Cancer Society and other groups, government health officials have backpedaled, saying that the guidelines don’t set federal policy and that women should continue what they have been doing.
That is smart advice and the kind of message women need to hear. As someone who recently had her first mammogram, I can tell you firsthand that it’s not comfortable.
But when I think of women like Kim Nickell, who would not have known were it not for early detection, I’ll gladly have my breast squeezed like a pancake.
It’s a small price to pay, Nickell said.
“If I had waited until I was 50, I could have died.”