Mammography Guidelines
Posted 3/11/2011
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You probably remember the debate that erupted more than a year ago when a government Panel issued new guidelines for mammography. Remember that guidelines always are directed towards women who have not had breast cancer; that is, they are about screening, not about diagnosis (hence the difference in screening vs diagnostic mammograms, you maybe have heard them called one or the other). For us, there has never been a question that annual mammograms are recommended and, for some of us, annual breast MRIs as well. If you are in the group for whom MRIs are suggested, it is usually wise to schedule the two tests so you have something every six months--and each one once a year.
Who generally has breast MRIs as well as mammograms? For sure, this is the usual plan for women who carry a BRCA1 or BRCA2 mutation and for women (like me) who have had more than one breast cancer. Beyond that, it becomes a "talk to your doctor" situation. At least at BID, I have never heard of this test being refused to a woman who requests it post breast cancer.
Anyway, here is a good summary of the current situation from the LA Times. I give you an excerpt and then a link to read more:
Without screening, 3.5 out of every 1,000 women ages 40 to 49 will die of breast cancer in the next 10 years; regular mammography can reduce that number to 3. The panel calculated that to save one life among women in this age group, 1,900 women must be screened annually for 10 years. The other 1,899 women will receive no benefit from mammography over that period, though they will field 1,330 call-backs for reassessment and 665 breast biopsies, and eight of them will be diagnosed with cancers whose prognosis will not be altered by detection via mammogram — either because they would never become dangerous or because they are so aggressive that there's little to be done.
Ultimately, the U.S. Preventative Services Task Force decided in November 2009 that whether the benefits are worth the risks is a value judgment each woman should make for herself.
"When it comes down to values, that's when you want to put it in the hands of patients and their doctors," says task force member Ned Calonge, a physician who at the time was the chief medical officer of the Colorado Department of Public Health and Environment.
The panel wrestled with the language, finally deciding to recommend "against routine screening mammography" for women in their 40s. The intention was to emphasize the word "routine," but instead people focused on the word "against," and "no one got beyond that," Calonge says.
Confusion and outrage ensued. The American Cancer Society, Susan G. Komen for the Cure and the American Congress of Obstetricians and Gynecologists criticized the task force recommendations and continued to call for annual or biennial mammograms for women in their 40s, in line with the panel's guidelines from 2002. The National Breast Cancer Coalition and other organizations that stood by the task force faced fierce criticism, and task force members found themselves defending their decision before a congressional committee.
http://tinyurl.com/4q9cgva
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