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Do I really need this?


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POSTED: Wednesday, November 25, 2009

Dr. Laura Peterson, Kapiolani Breast Center surgeon, said she has had more inquiries from physicians than patients about a federal task force recommendation that most women should delay mammography until age 50 and then be screened every two years instead of annually.

But she expects to be bombarded by women asking, “;Do I really need this?”;

Federal Preventive Services Task Force recommendations last week against routine mammograms for most women in their 40s caused an uproar and a lot of confusion since leading health organizations have recommended annual breast screening starting at age 40.

“;From the feedback so far, women want to get screened every year, and they are willing to go through the inconvenience or discomfort or whatever goes with it to be screened,”; Peterson said. “;Mammography finds 85 to 95 percent of breast cancers. That's a tremendous thing.”;

The 16-member task force, an independent group of experts appointed by the Department of Health and Human Services, last issued breast screening guidelines seven years ago. For its latest recommendations, the group gathered extensive data from studies, a National Cancer Institute database of mammograms, and scientific evidence to look at the benefits and risks of screening, how often and when it should be done, according to a New York Times article. Their research showed nearly the same benefits from screening every two years as annually with half the risk of harm and almost no benefit to screening women in their 40s.

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Panel members reportedly were stunned at the angry response to the research and to suggestions that their recommendations were intended to cut health costs.

In Hawaii the response in the medical community also has been largely critical of the task force's recommendations.

“;I think it is very scary writing off 40- to 50-year-old women from screening until their cancers become large enough to palpate. ... There is little question that mammography does save lives,”; said Dr. Scott Grosskreutz, Hilo radiologist and founder of the Hawaii Breast Society.

He said cancers tend to be more aggressive in younger women, and he will continue to encourage mammography at age 40.

The recommendations appear to be “;largely a public health cost-cutting measure,”; Grosskreutz said. “;Basically, the Federal Task Force is willing to accept a 10 to 30 percent increase in the breast cancer death rate between ages 50 and 75 by decreasing the screening interval to every other year.”;

At least 17 percent of breast cancers in women between 40 and 50 are found with mammograms, Grosskreutz said. If they waited until age 50 for screening, he said, “;Many of these would be at risk of delayed diagnosis and early death.”;

Jackie Young, breast cancer survivor and chief staff officer of the American Cancer Society Hawaii Pacific Inc., said she began getting mammograms when she was 40, but she missed a couple of years before getting a mammogram in December 1997 that found something suspicious.

She said she knows several women diagnosed with breast cancer in their 40s, and some died. “;I feel stunned by the comment that the statistics on costs don't bear out having a mammogram”; for most women in their 40s, she added.

About 17 percent of breast cancer deaths occur in women in their 40s, and 22 percent in women diagnosed in their 50s, she said.

“;It's true mammography doesn't catch every cancer,”; Young said. But improving technology will save more lives, she said.

Young and Dr. Virginia Pressler, Hawaii Pacific Health executive, returned Friday from American Cancer Society meetings in Los Angeles. “;The board said nothing should change,”; said Pressler, an ACS National Assembly delegate. “;Screening recommendations remain as they always have.”;

The reason the task force gave to delay breast screening to age 50 is that it is not as cost-effective in women in their 40s, Pressler said. “;When you find abnormalities it's less likely to be cancer; there are more false positives, and they're saying women go through all the stress and biopsies and it turns out to be negative. For women who actually have cancer, I don't think it's that much of an inconvenience.”;

Dr. Richard DeJournett at Koolau Radiology Inc. said the recommendations are “;potentially a great disservice to women. Avoiding the detection of breast cancer in the 40-to-50 age group is all that will accomplish.”;

DeJournett, who has been doing mammography since 1975, said he has noticed the incidence of breast cancer occurring in people younger and younger. When he started, he said, he was seeing cancer in age 50 to 60 or older women, then incidence slipped to women in the 30s and 40s. The youngest he has seen are in their late 20s, he said.

He said a good number of cancers will be undetected until they are masses if screening does not start until age 50, and “;we don't want something we feel as big as a mass to be the first sign of breast cancer. I've had a lot of patients doing mammograms who are saying, 'Not me. I'm going to have mine.'”;