Have we discussed the new breast cancer screening recommendations?

[astrid]

I've only popped in here and there, but am wondering what you ladies think about the new screening guidelines?

 

astrid :lurk5:

[Perry]

I've only popped in here and there, but am wondering what you ladies think about the new screening guidelines?

 

astrid :lurk5:

 

There was an excellent article about it at Respectful Insolence today. The author is a breast surgeon so he has a unique perspective on the issue.

 

I think the new guidelines are very reasonable.

[LisaKinVA]

IF it leads to better testing (as some hope, will include an annual breast ultrasound as part of the annual physical), I'm not worried.

 

HOWEVER, without the "better" testing, my biggest concern is for those who have aggressive forms of cancer and follow these new guidelines (no self-exams, especially in younger women). I can see the vast majority of young women thinking there was "nothing" to worry about, and then be jolted into reality when they are told they have stage 3 or stage 4 breast cancer, and they just thought there was some bad muscle ache in their back.

 

My fear is that those who "support" the new guidelines, under the auspices of "it will bring better, more accurate" testing will be sadly mistaken, and more women will need more aggressive treatment or die -- thus eliminating the health "savings" from NOT doing the screenings.

[momtoboys]

I am completely disgusted and against the new recommendations.

 

My sister w/ NO risk factors found her STAGE 3C (advanced) breast cancer through a BREAST SELF EXAM at age 29. Then, her doctor stalled at ordering a mammogram and told her "he's sure it couldn't be cancer at her age." Her cancer was then discovered w/ a mammogram after he finally ordered one after 2 months went by.

 

I know this will be a somewhat controversial statement, but I think we're seeing the beginning of what health care rationing will look like. The bottom line is, no one wants to pay for the mammograms.

[Mrs Mungo]

My aunt was 42 when diagnosed with breast cancer and my sister was 29 when she was diagnosed with stage 3, aggressive breast cancer in both breasts. So, I think it's crap. The problem (from my perspective) is that one aunt isn't enough to secure a "strong family history." If it took less to be moved into a high risk category with more screening then I would be fine with it. My family history is *now* strong enough that I am to get an MRI and a mammogram every year (one or the other every six months) but it took a lot to move me into that category.

 

My genetic counselor told me that among breast cancer patients less than 10% of the cancers are genetic. However, when women under 50 get breast cancer it is genetic 80% of the time. That's a massive difference. Women with a family history must be able to get genetic screening (my sister's insurance company would not pay for it for her) and women with the genetic markers need better screening.

[Haiku]

So what are the new guidelines?

 

Tara

[Mrs Mungo]

I know this will be a somewhat controversial statement, but I think we're seeing the beginning of what health care rationing will look like. The bottom line is, no one wants to pay for the mammograms.

 

I disagree with this. My military (socialist, government-paid) insurance has *much* better guidelines and screening practices than my 3 sisters' private insurance companies. Private insurance companies are about the bottom line-money, not about the health and welfare of the people under their care.

Edited November 18, 2009 by Mrs Mungo

[Mrs Mungo]

So what are the new guidelines?

 

Tara

 

They are laid out in Perry's link.

[G5052]

After a scare last summer post a routine screening mammogram, I'm "officially on" for diagnostic mammograms every year anyway. We have the federal program which still pays a good percentage of it anyway, at least last I checked.

 

I think it's confusing though, and assumes that women have a good doctor and/or can figure out themselves whether they should or not after 40.

[Perry]

I am completely disgusted and against the new recommendations.

 

My sister w/ NO risk factors found her STAGE 3C (advanced) breast cancer through a BREAST SELF EXAM at age 29. Then, her doctor stalled at ordering a mammogram and told her "he's sure it couldn't be cancer at her age." Her cancer was then discovered w/ a mammogram after he finally ordered one after 2 months went by.

 

I know this will be a somewhat controversial statement, but I think we're seeing the beginning of what health care rationing will look like. The bottom line is, no one wants to pay for the mammograms.

But if you have symptoms, it's not screening. Anyone with symptoms should ALWAYS have it pursued. The guidelines are only for *screening* asymptomatic women.

[Mrs Mungo]

But if you have symptoms, it's not screening. Anyone with symptoms should ALWAYS have it pursued. The guidelines are only for *screening* asymptomatic women.

 

My problem with it is that women with a strong family history also do not fit into these new suggestions. But, many GPs do not understand the screening guidelines. Originally, when I went to my GP for a mammogram, based on my family history he tried to talk me out of it. It wasn't until he talked to his supervisor (and I suspect got his butt chewed, given that he called me back at 8 am on a Saturday) that he set up my appointments.

[Mrs Mungo]

My doc told me to go have one at 35 (no family history). I didn't. I didn't want to. I'm too much of a worry wart.

 

See, I would worry more without it. I had both a mammogram and an MRI and felt better afterward. But, then, I have a strong family history that is extremely worrying.

 

It's weird how much doctor's vary on these things.

 

I think a lot of it probably depends upon their own experiences as doctors.

[G5052]

My problem with it is that women with a strong family history also do not fit into these new suggestions. But, many GPs do not understand the screening guidelines.

 

I can see a lot of patients and doctors thinking, "For 40-49, no screening mammogram needed." It's not that simple at all.

[momtoboys]

My sister did have the genetic testing, and it was negative.

[Sara R]

I'm another example: Stage 3C, diagnosed at age 32, no family history, no genetic marker, no risk factors, blah blah blah. Got a golf-ball sized lump that popped up out of nowhere 2 months after a clinical breast exam (discovered incidentally, not through BSE). Luckily treatment was effective and I am still here. Come to think of it, today is my 4 year cancerversary :party:

 

The main problem is that screening mammography is mostly ineffective before age 50. It's not that young women don't get breast cancer; they do. There's just no good way to screen for it. Ultrasounds are ineffective as a screening tool. They are good for checking out individual lumps though. MRIs are expensive and find many false positives, which leads to unnecessary biopsies (unnecessary expense, scarring which might make it more difficult to detect future cancer since scar tissue looks like cancer on the screen if I recall correctly).

 

Young women (under 40) who get breast cancer tend to be diagnosed at later stages and have worse mortality rates than older women. It's terrible. Stats from Young Survival Coalition:

 

Young women CAN and DO get breast cancer. While breast cancer in young women accounts for a small percentage of all breast cancer cases, the impact of this disease is widespread: There are more than 250,000 women living in the U.S. who were diagnosed with breast cancer at the age of 40 or under, and approximately 10,000 young women will be diagnosed in the next year. But, despite the fact that breast cancer is the leading cause of cancer death in women ages 15 to 543:

 

* Many young women and their doctors are unaware that they are at risk for breast cancer.

* There is no effective breast cancer screening tool for women 40 and under.

* Young women are often diagnosed at a later stage than their older counterparts.

* There is very little research focused on issues unique to this younger population, such as fertility, pregnancy, genetic predisposition, the impact of hormonal status on the effectiveness of treatment, psycho-social and long-term survivorship issues and higher mortality rates for young women, particularly for African-Americans and Latinas.

* Young women diagnosed with breast cancer often feel isolated and have little contact with peers who can relate to what they are experiencing.

* As the incidence of young women with breast cancer is much lower than in older women, young women are underrepresented in many research studies.

 

Anyone with a lump should get it checked out, and checked out means biopsied. They can get an idea of what it is by looking at a mammogram or ultrasound, but you just can't be sure without a biopsy.

[TravelingChris]

I think the reporting on these recommendations have been terrible. The don't say why they don't recommend screening mammograms before 50 or after 75. They don't say why your doctor should not check your breasts when you have your annual gyn appointment. (That is the one that is really perplexing me since I depend on doctors to be able to feel what is normal or abnormal better than me). I do understand the point behind dropping the BSE since I think it probably led to lots of invasive procedures that were unnecessary and not much actual detection of cancer. But much more needs to be said and done. When my daughters asked me about it, I gave some of the same answers Sara K. did in the above post but I cautioned them that they need to actually talk truthfully about risks. I informed them that we dont have any breast cancer in our family but I didn't know whether other cancers were also linked (we have prostate cancer on both sides of them). I told them how other risk factors aren't mentioned very often like having terminated pregnancies (either abortions or miscarriages) or not having any pregnancies at all (Nuns have a high rate of breast cancer). I also told them that even if they did not have to do BSE when they get older, they do have to be aware of changes like in appearance. I want to see the scientific data and then decide for myself. However, I am not surprised that the reporting is so bad since science reporting is never done well by mainstream media.