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| Film Mammography A.D.A.M. |
The new guidelines for breast screening, released on Monday by the U.S. Preventative Services Task Force, have been causing confusion, division, outrage, and much discussion. Health professionals, breast cancer support organizations, breast cancer survivors, and health journalists have been speaking out on the recommendation to move screening mammograms from age 40 to age 50. Emotions have been running high, and the barrage of commentary is generating a fog of confusion and misunderstanding about mammography guidelines in general.
The Task Force based its study on traditional film mammography - but most radiology clinics now use digital mammography. In the report explaining their recommendations, the Task Force rated digital mammograms as having "insufficient data" as to their accuracy. The USPSTF is a fairly conservative organization in how they view data - they may have been using statistics that were not quite current. Now we know that digital mammograms are superior to film mammograms: they are faster, use less radiation, and according to the National Cancer Institute, they are more accurate than film at finding cancer in women less than 50 years old, and women who have dense (not fatty) breast tissue.
Based on current facts like these, many prominent agencies are not changing their breast screening guidelines. The American Cancer Society as well as the National Cancer Institute have issued statements maintaining their current recommendations to begin screening mammography at age 40, doing monthly breast self-exams, and having a physician do a clinical breast exam once a year. Other notable organizations are sticking with the "start at 40" guidelines - the American College of Radiology, the American College of Obstetricians and Gynecologists, and the National Comprehensive Cancer Network stood together citing that the benefits of screening mammography from age 40 and monthly BSEs outweigh the risks. State regulations, which affect insurance coverage, will also affect the age at which women will be covered for their first screening mammogram.
Dr. Susan Love has come out on the side of the U.S. Preventative Services Task Force, saying, "While this is a shift in guidelines, it was long overdue, and now brings us into line with most other countries, many of which have government funded mammography screening programs." Some advocacy groups like Breast Cancer Action and the National Breast Cancer Coalition say that, "fewer mammograms is good news."
The United States is currently haggling over health care reform, and some fear that mammograms will in future be rationed, leaving many without screening when they actually need it. Dr. Gail Lebovic, a breast surgeon with 20 years experience, reminds women that, "Here in the United States, over 50% of the cancers we find are found on a mammogram. They cannot be felt by a woman, they cannot be felt by a doctor. So, without screening mammography, we would not have been able to make the progress that we have been able to make over the last 30 years." The American Society of Breast Disease, for which Dr. Lebovic is president, is concerned that the new USPSTF Guidelines are aimed primarily at cost effectiveness.
Let me have your comments on this controversy. Would you give up screening mammograms before you turn 40? Would you give up monthly breast self-exams?
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My 85 year Mother had breast cancer and beat it and I do not think it’s ever to early or to late!
When someone close to you has it everyone not touched by it before will know what I mean.
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In reality the individual point of view are clear advantages of early screening for breast cancer after 40 years of age. However, we consider that women need to know that the trace started at this age can also cause some damage, according to the anxiety caused by false-positive exams and occasionally breast biopsy for diagnosis.
How well said Dr. Gail Lebovic, President American Society of Breast Disease, the new guidelines of USPTF have been causing confusion, division, anger and a lot of discussion. However, even in the U.S. it is a reflection on the exaggeration of introduction, low quality of examinations, test results were inconclusive, incorporations uncritical technology and a large portion of the excluded population, remained the status quo of the delay, underdevelopment, disease, locally advanced, high cost of diagnosis and treatment. Any screening test has the benefit of early diagnosis, but due to the high sensitivity brings in the midst of false positives, the similarity of the cervix, prostate, etc.. In this study, the similarity of the Canadian study of the past, the USPTF was analyzed using data from conventional mammography, when the currently most clinical uses of high quality digital radiology, and is quite different sensitivity and specificity in this age group. We must also agree that it is true that due to the lower prevalence of disease in this age group to conventional mammography is less effective in early detection of breast cancer considering only as an outcome to be analyzed mortality. However, it would be impossible to renounce the vast benefits of minimal surgery in the breast and axillary treatment in breast cancer we provide to these patients when cancer is detected in its subclinical course and today we can only do that by mammography quality.
The fact is that there is no medical evidence that self-breast examination as public health policy has some impact, but of course can be of great value in terms of individual responses of incidental discovery of a breast lump. At issue is whether to continue encouraging women performing self-examination, transferring them to a state policy and ignoring many situations in the care of women’s health when the breasts are not even considered. Based on current events like these, I believe that the SBM should not even consider changing or revising their guidelines and increasingly encourage and support organizations and governmental bodies for the design of public policies for women with focus on early detection breast cancer
There is so much controversy on this issue and everyone thinks he/she is right. Confusion makes a bad situation worse.
I believe we have to keep our feet on the ground, and our heads thinking clear thoughts; we have to stop and listen to our bodies, our hearts, our intuition, and/or our guts.
My perspective is this:
If I had a mammogram at age 40, it would have shown a small cancer which would have been easily treated.
I was refused a mammogram and instead I had to deal with mastectomy, chemotherapy, fear of dying at a young age, etc.; in short it was a major impact on the health care system, and on me, my family, and friends.
Until there’s a better test, mammography is still the gold standard for breast cancer screening.
Until the cure for cancer is known by more people, early detection is of great importance because it can save lives.
It seems there are many women dying of breast cancer at a young age, which I believe is a tragedy and this should be prevented.
This should never happen! Early detection gives the best hope and options!! I have witnessed the age of women with breast lumps as early as the twenties! Please get your mammograms and don’t stop your self exams. Both of these methods have saved me twice!!!
In 1997 at age 50, I was diagnosed with DCIS, a non-invasive ductal carcinoma of the left breast. It was discovered as a questionable ’spot’ on a routine mammo screening and confirmed with ‘additional views’. Thankfully it was seen when it was, otherwise it would have become invasive and my life would have been very different in terms of treatment and outcome. Gals AND guys need to know their bodies, but what was a ’spot’ for me and not something that could be felt until too late, would have become a full-blown tumor if not for the routine mammo started at age 45 as preventative. There was no known family history.
If I had not had a mammogram at age 46 it is unlikely that I would be able to comment on this today. Mine was a tumor that even the most experienced breast surgeon could not feel. I am grateful to be one of the many breast cancer survivors. This would not have been possible without having had a mammogram in my 40’s!
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