Current Conditions
28°F - SNOW
(811) (640) (204) (113) (47) (44) (18) (6) (4) (3) (2)
Local doctors are rejecting new recommendations that would push back the starting age and frequency of mammograms for women.
"We know that mammography has single-handedly reduced the number of deaths from breast cancer," said Dr. Sharee Livingston-Anderson, an obstetrician-gynecologist with OBGYN of Lancaster. "For now, I'm not changing what I'm doing."
Diagnostic radiologist Dr. John Nawa of Ephrata Community Hospital said, "Let me put it to you this way: I guess I've never been so worked up about anything in medicine as I am regarding this topic because it is near and dear to my heart. I'm pretty sure they're off-base with this."
The new guidelines released Monday recommend that most women should start regular mammograms at age 50, not 40, as is currently recommended.
Also, women ages 50 to 74 should have the test done every other year, not every year, according to the recommendations from the U.S. Preventive Services Task Force, which provides guidelines for doctors, insurance companies and policymakers.
The task force, an independent panel of experts appointed by the federal government, also said that doctors should stop teaching women to examine their own breasts.
The guidelines are designed to reduce the harms that come from "overscreening," which include false alarms and the associated unnecessary further tests and resulting anxiety that accompanies them.
A number of local doctors said, for now, they will not change the way they are doing things.
Many obstetricians-gynecologists are following the recommendations of the American Congress of Obstetricians and Gynecologists, which has not changed its views on mammograms in the wake of the task force recommendations.
The Congress recommends mammograms every one to two years for women age 40 to 49 and every year for women age 50 and older. It also advocates self-examinations.
Dr. Karen Roberts of May-Grant Obstetrics and Gynecology said regular testing leads to early diagnosis, which allows patients more treatment options.
Roberts wondered if the new recommendations are designed to save money. She said the task force itself noted that mammograms for women ages 40 to 49 do save lives.
"If we're going to save bucks, don't do it at the expense of women," she said.
Doctors said they all have seen younger patients whose lives have been saved due to early detection of breast cancer through mammography.
"There's a handful of women in our department alone who have been less than 50, diagnosed mammographically with a breast ultrasound and who are still around, who have kids and are doing real well," Nawa said. "It has made a difference."
Several doctors also said they have had patients who found their own breast cancer through self-examinations.
Doctors don't expect patients to diagnose their own breast cancer, but to detect changes in their breasts, Livingston-Anderson said.
Nikki Shaffer found a lump in her breast when she was 35. The nurse practitioner from Lititz underwent a bilateral mastectomy six months ago.
Shaffer, now 36, is outraged at the recommendations of the task force.
"If I would have waited until their screening time, 15 years from now, I wouldn't be alive," she said.
New technologies are making mammography more accurate, doctors said. Doctors are able to pick up cancers earlier, allowing for earlier treatment, Nawa said.
"I fear the consequences of putting this statement out," he said. "I think it's going to have deleterious effect on the detection of breast cancer as a whole if women were to adopt these guidelines. I think it's a step in the wrong direction."
Livingston-Anderson agreed.
"I'm afraid patients will say, 'Well, there isn't much value in mammograms.' I'm afraid if that happens, we're heading down a road we might regret. I think we run the risk of late detection."
Dr. Randall Oyer, the oncology program director at Lancaster General, said one size doesn't fit everyone when it comes to screening.
Doctors need to have careful discussions with their patients about the risks and benefits of mammography, he said.
Screening recommendations would be different for a patient in her 40s who has a family history of breast cancer or had a previous breast biopsy than they would be for a patient with no history of breast cancer who does not want to undergo unnecessary tests.
"We're going to have to have a heavy dose of patient involvement," he said.
The American Cancer Society also is not embracing the task force guidelines. The society is recommending women stick with guidelines for annual mammograms starting at age 40.
The society said the task force found that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened. For women age 50 to 74, one cancer death is prevented for every 1,339 women screened.
"With its new recommendations, the (task force) is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society, in a statement.
"Breast cancer is a serious health problem facing adult women, and mammography is part of our solution beginning at age 40 for average-risk women."
