Tuesday, December 22, 2009

What to make of the new mamogram guidelines?

I've got a couple years until I hit the big 4-0, but a recent cancer scare has made me start taking my health more seriously. There's a history of different types of cancer in my family, some fatal, on both sides. So when the new guidelines for mamograms came out last month, stating that annual screenings were no longer recommended for women younger than 50 (and that self-exams weren't helpful, either), I wasn't sure what to make of it. Wait 10 more years to start screening for something that's already in my family? Get tested for the BRCA1 cancer gene, and then decide? What?

I'll admit that my immediate reaction to the new guidelines was less practical and more along the lines of "if this was a man's issue, they'd be recommending more screenings, not less." After all, most health insurance plans cover Viagra but not The Pill, right? And breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. (More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.) Given the political focus on health reform, it's also easy to jump to the conclusion that this is really about heath insurance companies wanting to avoid paying for mamograms.

But it's not a male vs. female issue at all -- breast cancer does, indeed, affect men, too. Neither is the change all that sudden -- the data used by the government task force to determine the new guidelines has been around for years, according to the Los Angeles Times. Not to mention the fact that, up until a couple of decades ago, 50 was the age at which women were supposed to start getting regular screenings -- so if anything, we've returned to an earlier guideline.

The new guidelines are also more in keeping with those in other countries. Though the American Cancer Society has long recommended that women get annual mamograms starting at age 40, international guidelines call for screenings to start at age 50, just as the new US guidelines do. The World Health Organization recommends screenings every other year; in Britain, women get screened every three years.

What if you have a history of cancer in your family, or you test positive for the BRCA1 gene?
"You should talk to your doctor and make an informed decision about whether mammography is right for you based on your family history, general health, and personal values," said Dr. Diana Petitti, vice chair of the task force, in a statement.

So why change the guidelines at all? According the Associated Press, the task force concluded that "getting screened for breast cancer so early and so often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women's odds of surviving the disease."

There's the key word, right there: surviving. And I agree that it's a valid way to determine the usefulness of the screening. But what about the patient's quality of life? How does the treatment of the disease change when a tumor is discovered later rather than earlier? There's a huge difference -- in cost, in stress, in pain, in recovery -- between a lumpectomy and a radical mastectomy.

Actress Christina Applegate had a double mastectomy last year, a month after she was diagnosed with breast cancer -- at age 36. She started having mamograms, she told Good Morning America, when she turned 30.

Not 50.

"If this had been caught a year from now, or when I was 40, I probably wouldn't be able to live through this," Applegate said.

And that's my fear. The "what if?"

What do you think of the new guidelines?

1 comment:

Phe said...

I think that the guidelines are specifically aimed at the quality of life issue that you address. Living in fear and through unnecessary biopsies for so many women actually decreases their quality of life, not improves it.

I didn't click your link, but I wonder if Ms. Applegate had a history that caused her to make her decision to screen earlier, rather than at 40?

Frankly though, I haven't followed it much. I don't know my medical history (adopted, no records), but I know that in my adoptive family, Alzheimer's has been what's claimed more of my female relatives than anything - and none have succumbed to cancer of any kind. So Alzheimer's is my focus.

In this matter (breast cancer screening), I'll discuss it with my doc and go with what she recommends. But if I had a history of it that I knew of, I would have started screening in my late 20's or when I turned 30 too.

I just remember that these, like all other things medical, are guidelines - not regulations. I tend to discuss guidelines on all health matters (and baby raising matters too) with my doc and see what they say. But because these are guidelines and not regulations, I don't take them with much more than a grain of salt anyway and have treated it like the developmental scales for kids - I pretty well disregard them.