US Uproar Over New Age Rules For Breast Cancer Tests

by Thilaka Ravi on  November 19, 2009 at 11:48 PM Cancer News
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Doctors and experts are in uproar over new recommendations to increase the age of breast cancer screening, warning more women will die from the disease which already claims some 40,000 lives each year.
US Uproar Over New Age Rules For Breast Cancer Tests
US Uproar Over New Age Rules For Breast Cancer Tests

The high-level United States Preventative Services Task Force of scientists and researchers Monday recommended that breast cancer screening in women should now start at the age of 50 as opposed to 40.

And it further said that women between the ages of 50 to 74 should be screened every two years instead of annually.

"Screening saves lives, and cutting back on screening would cost lives," said Dr. Timothy Johnson, an oncologist at Holyoke Medical Center in Massachusetts.

"I'm against the proposals to cut back the screening on women between the age of 40 and 50, absolutely," he told AFP.

Some 210,000 American women are affected by the disease each year, and breast tumors are the most common cancer in women patients at Holyoke.

The task force's findings came two years after the panel issued a report which looked at the same issue, but did not recommend raising the screening age.

Some wondered whether the recommendations issued Monday were part of a cost-cutting effort as the United States wrestles to reform its health care system, something it wasn't doing two years ago.

But if that was the idea, cutting mammograms for younger women was not the way to go, said Dr Christine Pellegrino of the Montefiore-Einstein Center for Cancer Care in New York.

"Are they going to not reimburse mammograms for younger women versus potentially having to absorb the case of a woman who presents years later with advanced breast cancer where you're talking chemotherapy, surgery, more chemo, radiation and a great potential for recurrence?" Pellegrino, who is director of Montefiore-Einstein's breast clinic, wondered.

"Not only does that have a huge financial cost but also a devastating psychological impact," said Pellegrino, who was also opposed to hiking the starting age for breast cancer screening.

"If a woman shows up at 50 for her first screening and they find out she has this big cancer, and you know that if you had screened her a few years earlier you would have found it... whether you're the patient or the provider, if you have to say, 'Well, if we had done this two years earlier,' nobody will recover from that."

Mammograms currently cost the US public health system, Medicare, between three and five billion dollars a year.

One reason the task force gave for phasing out mammograms for younger women was the higher incidence of false-positive results in the group. These caused significant stress and led to unnecessary biopsies and treatment.

But cancer survivor Debbie Guardian said a false-positive was a small price to pay for catching the real thing in time.

"What's worse? A lot of stress only to find out it was plain old calcification or a lot of stress to discover you've got breast cancer but it's treatable because you were screened on time?" Guardian, whose doctors confirmed she had breast cancer days after her 50th birthday last year, told AFP.

"I went every single year (for a mammogram) starting at 40. Had I not gone when I was still 49, I wouldn't have known I had cancer because it wasn't big enough for me to feel, but it was big enough to be serious," she said.

"What this esteemed panel of experts is recommending is not wise, to put it politely. Based on personal experience, I wholeheartedly disagree with them," she said.

Pellegrino said the panel's recommendations went against years of efforts to raise awareness of breast cancer.

"With breast cancer, the money and resources we have poured into education and awareness is tremendous. Today, no matter where you go, women know something about breast cancer and something about having mammograms done," Pellegrino said.

"To start telling women, 'I know you just turned 40 but we're not going to do your baseline mammogram' -- the reaction is going to be one of complete visceral disbelief like, 'What do you mean I'm not going to have my mammogram'?"

According to this year's report, one life is saved for every 1,900 women aged 40-49 screened for breast cancer, compared to one life for every 1,300 in the 50-59 year age group.

"You may have to screen 1,900 women a year to save one life, but that's part of cancer screening," said Johnson. "We see a lot of women in their 40s with breast cancer, and by screening younger women, we save lives."

Source: AFP

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