My last breast cancer screening was “BC” before Kovid a few weeks before the mysterious new disease was detected in China. The timing was right: everything was normal, and by the time we moved into lockdown, my to-do list did not include mammograms.
But by November 2020, exactly one year after that scan, I was interrupted by phone calls and text messages to say that I was there for another reason.
“Mamo Matter,” shouted one in all big letters. “Breast cancer doesn’t take a break during an epidemic, nor should you.” I was well aware that the National Health Guidelines recommend only one mammogram every other year for women at average risk for breast cancer. But there has been a kyphony of advice in recent years as different groups repeat their recommendations, often contradicting each other. Hence the messages were unnecessary.
It turns out that my imaging center is not alone in harassing women to perform mammograms more often than optimal for the US Preventive Services Task Force gods. A recent study found that hundreds of breast centers tell women who are not at risk of cancer to have regular scans every year and start at 40.
The task force, however, recommends performing mammograms regularly every two years, starting at 50. Its guidelines recommend that women in their 40s discuss mammography with their doctors, evaluate risks and benefits, and come to an individual decision. (The panel’s recommendations extend to the age of ४४; it has stated that there is not enough evidence to make recommendations at that age.)
The new study, published in JAMA Internal Medicine on 15 March, was accompanied by a rather frightening editorial stating that additional screening could do “more harm than good”.
“I don’t think there are obvious financial benefits from increased mammography in breast cancer centers that are advising the patient, especially when it conflicts with the advice of the patient’s primary care provider and the advice of the work force,” Dr. Said Rita F.A. Redberg, Editor-in-Chief of JAMA Internal Medicine, who gave Dr. Wrote editorial with Anand R. Habib and Drs. Deborah Grady.
The American College of Radiology took umbrage, noting that it was “outrageous” that breast cancer centers were promoting mammograms for financial reasons, and radiologists had a different set of guidelines.
When the epidemic began, both routine checkups and appointments starting with disturbing symptoms such as the discovery of a lump were delayed as the facilities closed. Even when they reopened, many patients were hesitant to go inside.
But Dr., who chairs the Breast Imaging Commission of the American College of Radiology. Dana Smitherman said that breast center recommendations for more frequent screening predict epidemics.
“This study is telling us that breast cancer specialists in the US do not support these recommendations,” Dr. Smitherman said in an interview referring to the guidelines of the American Task Force.
In fact: Both the College of Radiology and the American Society of Breast Surgeons recommend annual mammograms starting at age 40 (Dr. Redberg’s institution, University of California, San Francisco, also recommends that schedule).
The American Cancer Society recently withdrew its recommendations, however, supporting annual scans starting at age 45, with the option to switch every other year at age 54. The American College of Obstetricians and Gynecologists recommend women begin mammography at the age of 40 on average. But “every one or two years.”
The debate over screening frequency for breast cancer – the second leading cause of cancer death for women after lung cancer – dates back to 2009. This is when the US Preventive Services Task Force, an independent expert panel that reviews the evidence and provides guidance to doctors. And insurers withdrew their mammography recommendations for women who were considered to be at average risk for breast cancer.
Screening can actually be harmful, especially for young women, who the panel found. False-positive findings can trigger unnecessary procedures such as biopsies or what experts call over-diagnosis – aggressive treatment of slow-growing tumors that may never become life-threatening, but different from fast-growing tumors Not possible.
When women underwent mammograms every other year, false positives and unnecessary treatment losses were reduced, the panel determined, while it was found that life-saving benefits remained relatively unchanged.
But some experts believe the panel overcame the disadvantages of more frequent screening. Proper schedules for screening can vary from doctor to doctor, and patient to patient, and have become quite confusing.
“Many women may not even be aware of the guidelines, or that there may be a downside to mammography, and that they have the option to begin screening at the age of 45 or 50,” Dr. Jennifer L. Marty, assistant professor of surgery at Weil Cornell Medicine who led the new study, said in an interview. “In almost every other country, women start at 50.”
While many women may believe that “breast cancer screening hurts health.”
Dr. Marty and his co-authors, Mark Lee and Neil Patel, two Well Cornell researchers, decided to investigate the recommendations posted on the websites of some 606 breast cancer centers in the United States. They found that more than half of the 376 centers have recommendations that differ from the US task force, saying that women at average risk for breast cancer should start imaging at age 40.
And 347 centers said that women should not only start at 40, but continue annually.
More rigorous screening may be appropriate for some high-risk groups, such as Ashkenazi Jewish women, who are more likely to carry mutations that place them at risk for breast and ovarian cancer, and black women, Those who were likely to be undervalued in mammalian screening tests, Drs. Marty said.
Women who want to help assess their personal risk to make screening decisions are Weil Cornell Medicine’s gynecologists, Drs. One can use an online tool developed by Margaret Polanjewski, and Elena Elkin, a research scientist at Memorial Slogan Kettering Cancer Center, suggested Dr. Marty.
For myself, I have been on a two-year plan for some time. I do breast self examination regularly, and also get clinical breast exam done. So even though I felt an idiom of irrational guilt after receiving the text message, I politely asked to stop calling a receptionist. I promised that I would be in touch.