I am very upset about this, having lost 8 friends in their 40s from breast cancer. I think this was all a ploy by the insurance companies to have an excuse to deny payment for women's health testing. I don't trust any insurance company to have my best interests at heart. Unbelievable that they'll cover the costs of Viagra but not for mammography.
1
The true source of these "guidelines" is the insurance industry which wants to reduce the number of mammograms that it covers. There are 69 million+ women age 40+ in the U.S. and it adds up to a lot of money. Read my breast cancer story posted at
http://mammogramsanddcis.blogspot.com (mammograms and dcis)
and you will see how misleading and self-serving all the information about breast cancer and screening is. You also need to know more about the use of MRI--light years better--for screening. Things are not the way they seem.
http://mammogramsanddcis.blogspot.com (mammograms and dcis)
and you will see how misleading and self-serving all the information about breast cancer and screening is. You also need to know more about the use of MRI--light years better--for screening. Things are not the way they seem.
2
We shouldn't freak out because they pushed back their recommendation on mammograms. This is just a guideline not a fast rule. Each woman's doctor needs to assess family history (if available) and decide whether their patient would benefit from this test before 45. I started being sent for mammograms just after 40 and I hated having them. They are painful and uncomfortable. Plus I have dense tissue so I had to have an ultrasound to make sure there wasn't anything untoward. Too many patients are being subjected to over treatment and that must stop.
1
Lets all calm down. ACS doesn't set mandates for care by hospitals or doctors. Neither does the USPSTF. They simply read data and come to conclusions. They both changed their guidelines on A LOT of Cancers not just Breast. ACS is media oriented and stirs the pot quite regularly with data to benefit monetarily in donation form. SO who do you believe? Who is right? Who mandates care and changes? ACOG American Colleges of Obstetrics and Gynecology, they have pretty much stayed the same on the breast Cancer front. That is who insurances and hospitals will listen to the Docs.
http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/ACOG-Practi...
http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/ACOG-Practi...
1
ACOG--umm not so sure that whose who the insurance companies listen to.
Can you post the statement from an insurance company that is who they rely on?
Can you post the statement from an insurance company that is who they rely on?
2
What remains carefully hidden from the discourse and the changes in mammogram guidelines into a direction opposite what the cancer business has been fiercely advocating for decades is the fact is there has never been any solid sound scientific evidence in support of mass mammography since its systematic introduction but since the beginning a solid body of data (actual evidence-based data) showed it is seriously harmful to most women and, therefore, mass mammography should have never been introduced in the first place (sources: "Mammography Screening: Truth, Lies and Controversy" by Peter Gotzsche and "The Mammogram Myth" by Rolf Hefti).
Yet here it is claimed these changes "The changes reflect increasing evidence that mammography is imperfect, that it is less useful in younger women, and that it has serious drawbacks" - all of it had been known in the 1970s/80s. It's just that the massive orthodox cancer business, especially the American Cancer Society, ignored or ridiculed the real evidence and consistently overstated the benefits of mammography.
This "change of heart" by this pawn group for the interests of corporate medicine is hypocrisy at its best (a move to save face?), it's corruption at its worst.
Mammography has always been about politics and marginally about science because if one had relied on the latter the test would have never a common medical practice from the get-go.
Yet here it is claimed these changes "The changes reflect increasing evidence that mammography is imperfect, that it is less useful in younger women, and that it has serious drawbacks" - all of it had been known in the 1970s/80s. It's just that the massive orthodox cancer business, especially the American Cancer Society, ignored or ridiculed the real evidence and consistently overstated the benefits of mammography.
This "change of heart" by this pawn group for the interests of corporate medicine is hypocrisy at its best (a move to save face?), it's corruption at its worst.
Mammography has always been about politics and marginally about science because if one had relied on the latter the test would have never a common medical practice from the get-go.
3
Early detection of breast cancer sounds great, but we tend to ignore the fact that all medical interventions can cause harm. And potential harms from screening mammography are not trival. There is no doubt that unnecessary breast cancer treatment has shortened lives to the point that there is no net mortality benefit from screening. Surgery, chemotherapy, radiation and estrogen-suppressing drugs all come with their own (small) risk of death. This is why screening mammography has never been shown to reduce all-cause mortality. Deaths from overtreatment cancel out lives extended via screening. Outside of the U.S. this has been acknowledged for some time.
http://www.bmj.com/content/346/bmj.f385
http://www.bmj.com/content/346/bmj.f385
8
'Fewer mammograms'! Well, the wheel comes full circle or is this the ACS just 'clearing the decks'? They acted several years back by no longer supporting regular PSA testing for cancer of the prostate, presumably taking the view that it was not a genuine screening tool? It is a healthy sign that institutions such as the ACS have the courage and capacity to review entrenched policy. PSA tests and their proper role in the management of prostate disease has taken a long time to develop. However, with the more conservative policy on mammograms now released, it appears 'screening' healthy individuals for two common cancers is somewhat in limbo. Time to take a deep breath.
1
Why aren't we all screaming for the best, safest diagnostic tools, rather than demanding they give us our mammograms back?
If MRIs and sonograms are safer, more accurate, and already standard diagnostic tools for other conditions, why in the heck would anyone want any sort of mammography schedule at all? Why do we have this scenario repeated endlessly: inconclusive mammogram; second mammogram; MRI/sonogram to figure it all out. Why aren't we jumping over the first two protocols to begin with?
And why, exactly, per several commenters below, are diagnostic centers actually refusing to honor doctors* prescriptions for those better tests?
But the biggest, most important question: why are we wasting research time and dollars on these ridiculous debates about the *right* mammogram schedule, when we desperately need accurate blood tests and other genetic diagnostic tools to identify and treat each specific subtype of cancer? Why are we still in the Dark Ages of cancer treatment? Why is it acceptable to carve women up like turkeys to *treat* disease? Why isn't all the money--not just some of it--in immunological research?
I know from personal experience with an auto-immune condition labeled as *incurable* that I can reverse flare-ups with--yeah, those scorned supplements. It*s likely that cancer is an aberration of the immune system. And we know that remission is a poorly-understood aspect of cancer--but a real one. Can we focus on the important stuff now?
If MRIs and sonograms are safer, more accurate, and already standard diagnostic tools for other conditions, why in the heck would anyone want any sort of mammography schedule at all? Why do we have this scenario repeated endlessly: inconclusive mammogram; second mammogram; MRI/sonogram to figure it all out. Why aren't we jumping over the first two protocols to begin with?
And why, exactly, per several commenters below, are diagnostic centers actually refusing to honor doctors* prescriptions for those better tests?
But the biggest, most important question: why are we wasting research time and dollars on these ridiculous debates about the *right* mammogram schedule, when we desperately need accurate blood tests and other genetic diagnostic tools to identify and treat each specific subtype of cancer? Why are we still in the Dark Ages of cancer treatment? Why is it acceptable to carve women up like turkeys to *treat* disease? Why isn't all the money--not just some of it--in immunological research?
I know from personal experience with an auto-immune condition labeled as *incurable* that I can reverse flare-ups with--yeah, those scorned supplements. It*s likely that cancer is an aberration of the immune system. And we know that remission is a poorly-understood aspect of cancer--but a real one. Can we focus on the important stuff now?
2
Everything in medicine is based on statistics. SURE, some people at would be dead without a mammogram - I don't doubt it. But for a particular person, with no known risk factors, you have to ask yourself: what are your chances? The rash of false positives, in addition to the expense, anxiety and hassle are good reasons NOT to get one. I chose not to have a colonoscopy - for precisely the same reasons. It's a personal choice, and given statistics, I should be fine. If not, well, that is the chance I am taking.
2
Just remember:Profit motive drives recommendations.
3
As just an ordinary, you know, woman, it strikes me as logical that women diagnosed with breast cancer at a young age would indeed have a very aggressive, likely lethal form of the disease for which treatment can perhaps barely extend life--and at great cost to the quality of that life.
And of course a younger woman--likely with a young family--will fight for every extra day. That is reasonable.
But it*s important to emphasize that many forms of aberrant cell growth are--uh--lumped under the term *breast cancer,* and definitions of disease, per a recent NY Times article, are changeable.
Every woman must decide what kind of life she wants for herself, and not just how long she wants to live. I hope for a healthy old age. I do not want a miserably-extended old age. At 65 now, if perhaps I have some indolent small tumor in my breast tissue, I don't really need to know that. I do not intend to go for invasive, painful diagnostic and treatment regimens that may harm my current ability to live an active life. I consider the longevity of my great-grandparents, grandparents and parents, and on the whole we are a long-lived bunch. My mother outlived her parents by three and two decades, respectively, and they died earlier than their own parents did. My father is still ticking at 94 and only one of his three siblings died younger than that.
The point is to make the choices that one can comfortably live with, and then not second-guess; we all must die from something.
And of course a younger woman--likely with a young family--will fight for every extra day. That is reasonable.
But it*s important to emphasize that many forms of aberrant cell growth are--uh--lumped under the term *breast cancer,* and definitions of disease, per a recent NY Times article, are changeable.
Every woman must decide what kind of life she wants for herself, and not just how long she wants to live. I hope for a healthy old age. I do not want a miserably-extended old age. At 65 now, if perhaps I have some indolent small tumor in my breast tissue, I don't really need to know that. I do not intend to go for invasive, painful diagnostic and treatment regimens that may harm my current ability to live an active life. I consider the longevity of my great-grandparents, grandparents and parents, and on the whole we are a long-lived bunch. My mother outlived her parents by three and two decades, respectively, and they died earlier than their own parents did. My father is still ticking at 94 and only one of his three siblings died younger than that.
The point is to make the choices that one can comfortably live with, and then not second-guess; we all must die from something.
2
The people making this recomm nation will find it hard to sell, because many articles comment on how much money it will save.
Do you ever ask yourself why the US has the world's highest per capita health care expenses but the worst health care outcomes in the developed world? A primary reason is because the health care/cancer/industrial complex, of which the American Cancer Society plays a leading part, has bombarded us with pink ribbons, unnecessary tests and treatments. Today increasing numbers of women are waking up to the fact that the physical, financial and emotional cost of screening mammograms simply do not justify their widespread use. It's about time.
3
I believe this ruling has come down from government pressure to cut expenses to our healthcare. Is there a similar change for men to have less checking up on their prostrate glands?
3
yes there is a similar recommendation for men.
2
https://www.washingtonpost.com/news/to-your-health/wp/2015/10/20/harvard...
The interview link above sites critical information not so far published here to the best of my knowledge My view is that the Times consistently oversells the non-expert views of panels whether it is the ACS or U.S. Preventive Services Task Force (USPSTF) — a national panel of physicians from the fields of preventive medicine and primary care — or some bogus piece of flim flam from who knows where. The Times simply loves studies and seldom subjects them to critical review. Or in fact provides very complete information. For instance the link below allows readers to see who the individuals at USPSTF are. The people who arbitrarily decid that less is more when determining your life expectancy. The American Cancer Society committee is made up of non medical experts just so you know.
http://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf
The interview link above sites critical information not so far published here to the best of my knowledge My view is that the Times consistently oversells the non-expert views of panels whether it is the ACS or U.S. Preventive Services Task Force (USPSTF) — a national panel of physicians from the fields of preventive medicine and primary care — or some bogus piece of flim flam from who knows where. The Times simply loves studies and seldom subjects them to critical review. Or in fact provides very complete information. For instance the link below allows readers to see who the individuals at USPSTF are. The people who arbitrarily decid that less is more when determining your life expectancy. The American Cancer Society committee is made up of non medical experts just so you know.
http://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf
1
if you look at that link, the USPTF is almost all MD's, many with additional degrees and a few PhD. RN's
1
I think this provides some very necessary information absent from coverage so far. Like hard hitting facts ignored by the non expert panel. I hope this gets in print here, it could save lives and is the only thing I'v read that cuts through the dubiously arrived at conclusions of the ACS.
Why this Harvard radiologist still recommends women get mammograms at age 40. By Meeri Kim October 20 at 4:00 PM
https://www.washingtonpost.com/news/to-your-health/wp/2015/10/20/harvard...
Why this Harvard radiologist still recommends women get mammograms at age 40. By Meeri Kim October 20 at 4:00 PM
https://www.washingtonpost.com/news/to-your-health/wp/2015/10/20/harvard...
2
A 2013 study at the Harvard teaching hospitals found that half of the women who died from breast cancer were diagnosed while in their forties. There are more than 30,000 women diagnosed with breast cancer in the U.S. each year while in their forties.
Only a quarter of women diagnosed with breast cancer each year have any of the known risk factors, such as genetic predisposition (BRCA 1 or 2 mutation), family history of breast cancer, or increased radiation exposure. If we only screened high-risk women, 75 percent of women diagnosed with breast cancer each year would not benefit from screening. Furthermore, the randomized, controlled trials showed a benefit from screening all women and did not separate women based on risk, so that we really have no proof that screening only high risk women will save any lives.
The arguments suggesting massive overdiagnosis — that is, when a woman is diagnosed with breast cancer that would not become a threat during her lifetime — have been completely manufactured. There is no evidence that invasive breast cancers found by mammography, if left alone, would not go on to become lethal. One of the authors of a major article published in the New England Journal of Medicine that has promulgated this misinformation has stated that his analysis was based on his best guess. Subsequent analyses have shown that the study's conclusions were completely false.
Only a quarter of women diagnosed with breast cancer each year have any of the known risk factors, such as genetic predisposition (BRCA 1 or 2 mutation), family history of breast cancer, or increased radiation exposure. If we only screened high-risk women, 75 percent of women diagnosed with breast cancer each year would not benefit from screening. Furthermore, the randomized, controlled trials showed a benefit from screening all women and did not separate women based on risk, so that we really have no proof that screening only high risk women will save any lives.
The arguments suggesting massive overdiagnosis — that is, when a woman is diagnosed with breast cancer that would not become a threat during her lifetime — have been completely manufactured. There is no evidence that invasive breast cancers found by mammography, if left alone, would not go on to become lethal. One of the authors of a major article published in the New England Journal of Medicine that has promulgated this misinformation has stated that his analysis was based on his best guess. Subsequent analyses have shown that the study's conclusions were completely false.
2
I am the poster child for mammograms, having had them since my 30s (my mother was diagnosed at age 38). "Dust" on the picture turned out to be a non-palpable tumor. Lumpectomy and radiation did the trick. (I had many prior biopsies, all negative). No other female relative had BC, and I was BRCA negative. What's wrong with being extra careful? Would you rather have a "false positive", followed by an "It's not malignant" biopsy, or pretend nothing could be wrong until you're 55, or you feel something. I know where I put my money - and my life. (and let's let them die with cancer if they only have 10 year life "expectancy". Really???)
4
Agree with you! I truly believe the insurance companies had a big hand in this report. I would also like to know the gender backgrounds if the people who supposedly made this recommendation.
I am a senior and two years ago I received a call back to get a sonogram since they thought they saw something but it wasn't a lump. I was scared. Last year I was about to have my sonogram when the Radiologist told me that I should not be having any more sonograms because it was a waste of money and not necessary. My mother's sister, one out of 5, had breast cancer but my chart indicated that it was not considered important in the scheme of things.
And what about breast ultrasounds as an additional screening tool where appropriate? These are necessary for women with dense tissue that the mammograms can't see through. It was an ultrasound that picked up Joan Lunden's breast cancer although her mammogram had missed it due to her dense tissue. None of my doctors can make heads or tails out of an manual exam, and the mammograms are always inconclusive, yet when they order ultrasounds the mammography facility (Lynn Sage Breast Center, a supposedly reputable place) acts like the ultrasound police and doesn't want to follow the doctor's order. I am reduced to having to make up a family history and point out the lumps that are always there with dense breasts as potential cancer to get them to do folllow the doctor's order. That's simply offensive that I am reduced to that to get my doctor's orders followed. There is no one size fits all way to diagnose, and people with different risk factors should be allowed the medical tests their physician's find necessary to evaluate the risk.
4
As someone who had a mammogram with a false-positive, I'm with these new guidelines. My biopsy was performed poorly by a male fellow, and I was left with a puncture wound that did not heal for 6 months. In Illinois, docs push you to get a mammogram, and I'm sure it's a money maker: the state reimburses mammograms regardless of insurance.
4
I have,had,yearly mammograms since my late 20's. Imagine my surprise when i did a self exam and felt a marble. Went in to see my doctor got a mammogram and wam at age 40 the Big C. 16 plus mammograms because of cysts and then cancer. I had one lumpon top of my chest wall. We need to get patient panels together to set guide.
2
My mother was diagnosed at 62 and dead by August that year. She was a nurse who believed that mammograms were useless. By the time she was diagnosed it had metastasised and was incurable. Therefor, I cannot agree with this study sorry.
3
My sister was diagnosed after one of her yearly mammograms at age 50 and died at 52, having experienced two years of all that repeated rounds of chemo, radiation, and surgery to do to her. Her mammograms didn't change that.
2
It appears that these decisions are made by men. Let's leave them to female physicians; they have a better idea of what it's like to have breasts and breast cancer. If mammograms had been accessible to my mother in the late '50s, she might have lived past 58.
Remember Thalidomide?
The drug was supposed to prevent miscarriages but caused birth defects.
Doctor: "I have good news and bad news. You won't have a miscarriage but your baby will look like Flipper."
Be very careful in regard to the medical "advice."
I know several women who were diagnosed with breast cancer in their early 40s.
Is this new "advice" a way to cut down on medical costs in a very shortsighted manner?
Or is a way to increase profits by doctors for when they treat Stage 3 or 4 cancer?
The drug was supposed to prevent miscarriages but caused birth defects.
Doctor: "I have good news and bad news. You won't have a miscarriage but your baby will look like Flipper."
Be very careful in regard to the medical "advice."
I know several women who were diagnosed with breast cancer in their early 40s.
Is this new "advice" a way to cut down on medical costs in a very shortsighted manner?
Or is a way to increase profits by doctors for when they treat Stage 3 or 4 cancer?
3
One of the main reasons we have reduced the death rate of breast cancer is early detection. Self exam, doctor exam, and mammography are all important parts of early detection. All can miss the diagnosis and do. The mass can be small and not palpable but picked up by mammography. Even a mass as large as 10 cm can be missed by mammography but picked up by exam. Women in their twenties can have breast cancer. So we need to think hard about reducing the protections we have developed and that have been a success.
2
I am confused - same old same old story about when to start and how often to get a mamo. This seems to come up each and every year at this time. Why tell someone or a doctor NOT to do clinical breast exams? Cleary we all know there is no HARM in that; in fact it could catch a lump! So why recommend not doing it at all. What is wrong with this world?
5
It frustrates me no end that more definitive ways of finding cancer in women's breast tissue is still so elusive. Once again, women's health takes a back seat to other health issues.
4
This still seems excessive. Who really needs that much radiation?
At home monthly breast exams are the least expensive, reliable way to screen your own breasts.
Mammograms remain an expensive, high-risk screening tool.
At home monthly breast exams are the least expensive, reliable way to screen your own breasts.
Mammograms remain an expensive, high-risk screening tool.
4
mammograms are not high risk
2
I am a physician and surgeon. The writer of the new recommendations is not only shirt sighted but also considering finances in mind and inappropriate. The best recommendations are that all men and women have genetic testing by age 15, and then those that are that a high risk individual should have breast MRI every year beginning age 35 or younger with family history of breast. A low risk should individual should begin breast Mri by age 40 and continue yearly. Mammograms are low quality and very high false negatives. This means the patient has a tumor but it's not detected. A false positive, is not so much a concern because you could do mri for better imaging. Biopsy if needed. Bottom line is that patients should be presented with all options and the best options first and let the patient decide what is best financially for them. The writer had finances in mind and should be excluded from doctors mind. It's not our responsibility to control cost which is what the government wants us to do. This leads to less than the best care. We as physicians should only make the recommendations as forementioned. My sister died last year of breast cancer at age 45 and diagnosed late in stage 4 at age 42. American Cancer Society and it's doctors suggesting this are misguided.
9
I agree. Money and insurance companies are behind this attack on women's health care.
1
If you are one of the people with an estrogen receptor positive (easy to grow, hard to shrink) tumor that also happens to be HER2 (this means there is a mutation on the cancer cells forming the tumor that makes them double in size every 4 months...) you are very pro-mammography at any reasonable age.
Breast cancer KILLS, if not on the first time then when it so frequently comes back years later. My best friend is trying to stay alive with stage 3b aggressive breast cancer that is positive for all those factors. Her life (and those of her sons, husband, and family) has been turned upside down as she fights for life. For the rest of her life, however long that is, she will have medical appointments and lose time and wages to treat this disease. The COST of breast cancer is extraordinarily high to those who bear it and more than justifies an abundance of caution in screening for it.
Breast cancer KILLS, if not on the first time then when it so frequently comes back years later. My best friend is trying to stay alive with stage 3b aggressive breast cancer that is positive for all those factors. Her life (and those of her sons, husband, and family) has been turned upside down as she fights for life. For the rest of her life, however long that is, she will have medical appointments and lose time and wages to treat this disease. The COST of breast cancer is extraordinarily high to those who bear it and more than justifies an abundance of caution in screening for it.
6
I had my baseline at 40. Stage II aggressive BC was discovered. I am now 60 and have lived to see my three children grow up and welcome two grandsons. I would not be here if I had waited until I was 45. I would gladly trade my cancer diagnosis for several false positives. I thank my lucky stars that this "new" recommendation was not yet in place.
14
I had ten centimeters of estrogen negative DCIS at the age of 39. I find it rich that there is so much debate about the overtreatment of DCIS (yes, there are cases that are overtreated) without talking about the diverse range of cases that share that label or that some cases are undertreated. Likewise, all these debates concerning the guidelines highlight the need for a much more nuanced and individualized patient-centric approach. How about this? Doctors should always get a thorough medical and family history of patients, including other risk factors (flight attendants, for example, have a higher rate of breast cancer) and should follow tiered guidelines according to risk. The higher risk groups should have the option of receiving earlier surveillance. Of course, that doesn't answer the looming question of all those cases of no family history. I think women should be given the option of starting surveillance earlier. For those concerned about unnecessary radiation, sonograms are a decent option. I don't pretend to have all the answers. This is a complex and nuanced issue, but I don't feel this is coming across in the guidelines and policies that are currently being discussed.
3
What the research really shows, in a nutshell, is that mammograms have been failing pre-menopausal women, for whom breast cancer is more likely to be lethal.
There are plenty of theories but no hard evidence of why this is so. I'm a typical case -- I was diagnosed at 44 with an aggressive cancer that failed to show up on mammogram. Mammograms only spot calcifications, and my cancer wasn't producing any.
Perhaps ironically, missing my annual mammogram is what prompted me to do a self-exam, which is how I discovered my cancer. I would be dead without that annual mammogram "nudge" from my doctor's office, but not because mammography itself was of any use.
During my treatment (at a major regional National Cancer Institute clinic) I heard repeatedly: the majority of pre-menopausal patients found their cancers on their own.
Scary? You bet it is! There are no reliable breast cancer screening tests for pre-menopausal women (who tend to have more aggressive forms of the disease). None. zip. zilch. nada. Except for the small minority of women with a BRCA mutation (they represent only 10% of breast cancer patients), we're all completely in the dark with this disease.
There are plenty of theories but no hard evidence of why this is so. I'm a typical case -- I was diagnosed at 44 with an aggressive cancer that failed to show up on mammogram. Mammograms only spot calcifications, and my cancer wasn't producing any.
Perhaps ironically, missing my annual mammogram is what prompted me to do a self-exam, which is how I discovered my cancer. I would be dead without that annual mammogram "nudge" from my doctor's office, but not because mammography itself was of any use.
During my treatment (at a major regional National Cancer Institute clinic) I heard repeatedly: the majority of pre-menopausal patients found their cancers on their own.
Scary? You bet it is! There are no reliable breast cancer screening tests for pre-menopausal women (who tend to have more aggressive forms of the disease). None. zip. zilch. nada. Except for the small minority of women with a BRCA mutation (they represent only 10% of breast cancer patients), we're all completely in the dark with this disease.
11
I am not sure why you are deterring women from either "it's not binary" YOU CAN DO BOTH. You can do self exams while getting annuals and why does anyone BUT INSURANCE COMPANIES Tell anyone well stop doing mammograms we have no alternatives but we just aren't finding that many. If YOU are the one of many that was found with early detection is their any amount of money or justification THAT WOULD EXCUSE never doing anything at all. like I always say CHARITY In the USA IS BIG BUSINESS including the American cancer society. A cure is the LAST thing anyone in the business of charities is looking for.
Oh and buy the way they have found the cure for cancer (HBOs show vice killing cancer the cure will be available fast tracked by FDA in two years) ask yourself why know one is reporting on it and why you a cancer survivor haven't brt
Oh and buy the way they have found the cure for cancer (HBOs show vice killing cancer the cure will be available fast tracked by FDA in two years) ask yourself why know one is reporting on it and why you a cancer survivor haven't brt
Before the days of mammograms I had two surgical biopsies of lumps found during an annul physical. Fortunately, both were benign. At the time I was 39 and 43. I now space out my mammograms to two or three years but do self exams.
2
I shake my head when I hear "it's the best we have" when referring to the mammogram as the gold standard test to detecting breast cancer. My response is: Why is it the best we have? Why are women STILL subject to this primitive, painful, and not very effective breast cancer screening procedure? Because we're doing our due diligence to appease our doctors and our peers and because we don't know what else to do. Until women stop having mammograms and demand something better, we're stuck with "the best we have."
4
Yes, the war on women continues. Who knew that republicans controlled the medical industry. You got to hand it to them, they are awfully industrious and busy destroying everyone's quality of life.
3
It is criminal that insurance will not pay for thermography. That should be the gold standard.
2
Yet AvMed in South Florida is still maxi-pushing mammograms and colonoscopies in both obnoxious letters and even more strident phone calls to its Medicare policy holders. The tone of the unsolicited phone call is one of a truant officer rounding up naughty kids who haven't been in for their mammo or col. When the caller fails to sell a mammo, she switches off to the wonders of a colonoscopy. Eventually, she allows that "Of course it's your right to refuse these necessary tests."
My right? You betcha.
I can only assume that there's a big-time financial incentive for AvMed doctors and radiologists to bill Medicare for reimbursement on these procedures.
My right? You betcha.
I can only assume that there's a big-time financial incentive for AvMed doctors and radiologists to bill Medicare for reimbursement on these procedures.
5
Reading these comments, one would think that the ACS was advocating for NO mammograms. It still recommends yearly testing from 45-54, then every other year until...80,85 or so. That is around 25 mammograms just for low risk women! No one is dumping the diagnostic tool altogether.
It's important to remember that mammograms can lead to illness and/or death, not because of the radiation which is arguably minimal or the anxiety from a false positive, but from the cascade of interventions that result from a positive mammogram. That includes everything from biopsy (every time we cut someone open we expose them to infection, and in this age of antibiotic-resistant antigens that is NO joke) to life-threatening chemotherapy for cancer that was never going to kill you.
There is a reason the data show what they show. The American Cancer Society is not out to get you or keep you from treatment. The ACS wants to prevent serious illness and death. They make recommendations based on a very comprehensive review of the data in order to minimize illness and death. That is why they cannot make recommendations based on anecdotes, despite the many passionate stories presented here.
It's important to remember that mammograms can lead to illness and/or death, not because of the radiation which is arguably minimal or the anxiety from a false positive, but from the cascade of interventions that result from a positive mammogram. That includes everything from biopsy (every time we cut someone open we expose them to infection, and in this age of antibiotic-resistant antigens that is NO joke) to life-threatening chemotherapy for cancer that was never going to kill you.
There is a reason the data show what they show. The American Cancer Society is not out to get you or keep you from treatment. The ACS wants to prevent serious illness and death. They make recommendations based on a very comprehensive review of the data in order to minimize illness and death. That is why they cannot make recommendations based on anecdotes, despite the many passionate stories presented here.
13
Here is an excuse for insurance companies to deny mammograms to women outside of these guidelines.
In other news, the age of prostrate screening was recently rolled back for those at risk.
In other news, the age of prostrate screening was recently rolled back for those at risk.
4
Some comments here question the integrity of the ACS. Dr. Richard Wender, ACS' cancer control officer, was Chairman of Family Medicine at Thomas Jefferson University in Philadelphia before going to ACS. Dr. Wender was my primary care physician for almost 30 years. His judgment and integrity are stellar. I've never known a medical professional who is more respected and loved by colleagues and patients. From my own discussions with him about mammograms, I know that this decision was not made lightly.
3
He may be an excellent physician, superb primary care physician but deals with mass numbers now and economics, as dictated by the insurance companies, etc. However, he is not a Radiologist- specifically a Mammographer- and does not deal with mammograms and woman's lives every day.
Who now does he answer to- certainly not his patients anymore
Who now does he answer to- certainly not his patients anymore
3
Wait, I thought the science was settled.
In some ways, Derek, science is never "settled". It's an ongoing matter of observation and hypothesis, in which even long-standing theories are changed when facts warrant that. It can yield some good probabilities, some on which we gamble our lives daily (such as in our use of cars and other machinery), but it is not expected to be 100 percent unchanging; if so, it would be called "dogma" like you find in a church, and not theory or recommendation or such terms as those.
6
No kidding, you might want to spread the news to the climate zealots
2
Now a days, the basic advice in the textbooks on medical science to women to have the first childbirth before 30 and the chances of having breast cancer is twofold in the opposite cases
not heard anywhere. Radiation in any form is not acceptable.
Few years ago, I read an article in BBC News suggesting Alpha ray in place of X ray for mammogram, indeed alpha ray is less harmful than x-ray .
The best advice to prevent, start from the correction in the food habits ,mainly give up Smoking and Red Meat consumption .
May NYT come out with the findings of ' consumption of Red meat and breast cancer" among ladies.
not heard anywhere. Radiation in any form is not acceptable.
Few years ago, I read an article in BBC News suggesting Alpha ray in place of X ray for mammogram, indeed alpha ray is less harmful than x-ray .
The best advice to prevent, start from the correction in the food habits ,mainly give up Smoking and Red Meat consumption .
May NYT come out with the findings of ' consumption of Red meat and breast cancer" among ladies.
1
my friend had the first of her 14 children before 19, breast fed them all and died at 50 from breast cancer. She was not a smoker and did not drink alcohol.
Similar with my cousin and her seven children and stage 4 breast cancer in her 30s. Estrogen-fed tumors grow tremendously quickly with hormone saturation of pregnancy. There's no one size fits all answer.
The idea that any cancer research is determined to wipe out cancer, eliminating perhaps 200,000 (or more) jobs and removing several billion dollars a year from the economy is laughable.
Last year, ACS reported $919 million in total revenue and net assets of $1.281 billion, according to its Internal Revenue Service (IRS) Form 990.
They just appointed a new CEO, Gary Reedy. The previous CEO, Seffrin, earned total compensation of $856,442 as CEO of the American Cancer Society last year, in addition to $77,859 as president of the ACS Cancer Action Network. I am certain Reedy is getting more than that, but they won't say.
What right does a non-profit have to hide the CEO's salary? Absolutely none.
These people want to eliminate cancer the same way the American military and its very wealthy suppliers want to eliminate war and the DEA wants to eliminate drugs.
What they're interested in doing is finding ways to 'manage' the illness that keep the cash register ringing without actually curing anything. Remember: just over forty cents out of every dollar you give them goes to supporting the beast (fundraising and salaries), less than sixty cents is spent on actual research and services.
That is ABYSMAL in this sort of organization.
Last year, ACS reported $919 million in total revenue and net assets of $1.281 billion, according to its Internal Revenue Service (IRS) Form 990.
They just appointed a new CEO, Gary Reedy. The previous CEO, Seffrin, earned total compensation of $856,442 as CEO of the American Cancer Society last year, in addition to $77,859 as president of the ACS Cancer Action Network. I am certain Reedy is getting more than that, but they won't say.
What right does a non-profit have to hide the CEO's salary? Absolutely none.
These people want to eliminate cancer the same way the American military and its very wealthy suppliers want to eliminate war and the DEA wants to eliminate drugs.
What they're interested in doing is finding ways to 'manage' the illness that keep the cash register ringing without actually curing anything. Remember: just over forty cents out of every dollar you give them goes to supporting the beast (fundraising and salaries), less than sixty cents is spent on actual research and services.
That is ABYSMAL in this sort of organization.
6
I just can't get on board with decreasing screening tests for cancers. I know mammograms aren't perfect. I know that they sometimes lead to unnecessary biopsies- but when I think of the alternative it seems worthwhile to me to do the testing. And in the back of my mind I always have my two colleagues who were both diagnosed with breast cancer at their initial mammogram at age 35. Because just a few years ago that was the thing- get your baseline mammo at 35! So I hope my insurance will continue to allow annual mammograms starting at 40 until I feel more comfortable with the odds of finding and beating breast cancer without them.
7
With all due respect, this is about what the data tell us, not about our feelings. It seems intuitively correct that more screening leads to fewer cancer deaths, but the facts don't bear that out.
Here's hoping researchers will soon find ways to determine which breast irregularities (as in DCIS) will go on to become life threatening, and which could be left alone. That will both save lives, and spare many of us from having invasive, life-disrupting medical procedures.
Here's hoping researchers will soon find ways to determine which breast irregularities (as in DCIS) will go on to become life threatening, and which could be left alone. That will both save lives, and spare many of us from having invasive, life-disrupting medical procedures.
2
What? I'm 62 and -- never having had a mammogram -- you're telling me I don't need one?
Well, shut my mouth. Better yet, stop bugging us with all your misguided cancer prevention bupkis. I'm a better judge of what my body needs. That's why I'm on zero prescription meds.
But every time I turn on a football game, I see more and more pink trimming the field, the athletes and the advertisements than I could ever imagine. Somebody's getting very rich off of breast cancer.
Well, shut my mouth. Better yet, stop bugging us with all your misguided cancer prevention bupkis. I'm a better judge of what my body needs. That's why I'm on zero prescription meds.
But every time I turn on a football game, I see more and more pink trimming the field, the athletes and the advertisements than I could ever imagine. Somebody's getting very rich off of breast cancer.
18
Exactly. Especially those execs at Susan G. Komen.
8
While I agree with your comments about the breast cancer PR machine, I feel I have to point out that this issue is not about "prevention" but rather "detection" - two very different things. You may never have needed a mammogram, but I personally know three women who died of breast cancer before their 40th birthdays. It wasn't their fault for not listening to their bodies, they obviously had more aggressive forms of the disease that weren't caught early enough. You have a health regimen that works for you, and maybe you are lucky enough to not have any common risks for this or other diseases, but it's quite callous to suggest that other women are too stupid to care for themselves properly.
4
For younger women diagnosed with aggressive breast cancers but no family history of the disease: Did either parent ever smoke, especially near the time of conception, during the pregnancy, and/or afterwards? What were the parents* work environments like? Was there heavy use of pesticides, indoors or as lawn treatments? What was the nutritional status of both parents pre-conception?
It would be worthwhile to begin developing these environmental histories for all women diagnosed with breast cancer. It*s not one disease, but many complex biological misfires; the causes may be as varied as each person*s genetic history. But creating detailed histories may help to identify either broad patterns or strange anomalies.
Who knows what the tipping point is for each person who develops cancer? One person might have grown up in a fog of Raid and be as strong as the proverbial ox and reach a hearty advanced age. Children of dedicated organic vegetarians sometimes die of cancer.
There will never be one answer that works for all people, and especially not with this disease.
It would be worthwhile to begin developing these environmental histories for all women diagnosed with breast cancer. It*s not one disease, but many complex biological misfires; the causes may be as varied as each person*s genetic history. But creating detailed histories may help to identify either broad patterns or strange anomalies.
Who knows what the tipping point is for each person who develops cancer? One person might have grown up in a fog of Raid and be as strong as the proverbial ox and reach a hearty advanced age. Children of dedicated organic vegetarians sometimes die of cancer.
There will never be one answer that works for all people, and especially not with this disease.
2
As a response to the confusion generated by conflicting mammogram screening guidelines, we've developed a Decision Aid for women ages 40-49.
http:breastscreeningdecisions.com
The Decision Aid includes individualized breast cancer risk assessment, lays out the benefits and harms of screening mammography,shows outcomes (mortality) for the various screening schedules, and allows women to clarify their values and concerns related to breast cancer screening. Users of the decision aid can print out a summary to bring to their heath care provider, to serve as a tool for shared decision making around when to start and how often to have screening mammograms.
We piloted the Decision Aid in tow large primary care practices, and found it to be well accepted by women and their clinicians alike. Publication of this trial is pending, but the decision aid is publicly available now.
We hope that it will help women make informed decisions around mammography in the face of conflicting and confusing guidelines.
Margaret Polaneczky, MD
Associate Professor of Obstetrics and Gynecology
Assistant Dean for Human Research Compliance.
Weill Medical College of Cornell University
New York City
http:breastscreeningdecisions.com
The Decision Aid includes individualized breast cancer risk assessment, lays out the benefits and harms of screening mammography,shows outcomes (mortality) for the various screening schedules, and allows women to clarify their values and concerns related to breast cancer screening. Users of the decision aid can print out a summary to bring to their heath care provider, to serve as a tool for shared decision making around when to start and how often to have screening mammograms.
We piloted the Decision Aid in tow large primary care practices, and found it to be well accepted by women and their clinicians alike. Publication of this trial is pending, but the decision aid is publicly available now.
We hope that it will help women make informed decisions around mammography in the face of conflicting and confusing guidelines.
Margaret Polaneczky, MD
Associate Professor of Obstetrics and Gynecology
Assistant Dean for Human Research Compliance.
Weill Medical College of Cornell University
New York City
4
Thank you for posting this. I've discussed mammograms with my doctor, but I'll take a look at that website, too.
Who's going to give my two friends back their nice breasts?
3
I feel for them.
I'm trying to be objective and apply the population medicine concepts here but I find this truly disturbing. Why would we scrap both screening tools? I might have skipped my next mammogram since I had a "normal" one last November. Only with hindsight, was the 1cm lump that I found at home in August visible on that mammogram, and even on the prior year's, according to the peer review by radiologists. Only an MRI revealed 2 additional, larger areas of disease and was critical in terms of changing my staging and treatment plan. I am a 46 year old with triple positive IDC undergoing neoadjuvant chemotherapy with mastectomy planned for January. I am also a nurse-midwife by profession so I have done thoussands of breast exams during my career. The rationale for not doing CBS is that it "might take 5-6 minutes" that could be better used for something else? I always spent those minutes teaching SBE technique to my patients. When I go back to work, I'll keep doing that in addition to a thoughtful conversation about mammography which will probably take 5 more minutes.
From The New York Times:
American Cancer Society, in a Shift, Recommends Fewer Mammograms
The group says women should start having mammograms at 45 and continue yearly until 54; it previously recommended mammograms and clinical breast exams every year
From The New York Times:
American Cancer Society, in a Shift, Recommends Fewer Mammograms
The group says women should start having mammograms at 45 and continue yearly until 54; it previously recommended mammograms and clinical breast exams every year
2
I have a cancer diagnoses, as disconcerting as it was I'm glad I found out. I've had a series of biopsies, not that big a deal and again, I'm glad when cancerous activity was detected. Early detection made treatment easy, fast, and effective.
If one reads the entire article the consensus summation is that each women's particular situation in consultation with her physician should dictate the screening level. One might ask why these recommendations are made especially when there is little consensus among the experts.
So if you are Ashkenazi living in Marin County or along the Columbia River or other breast cancer hot spots, or you have a family history the report is not relevant. It is intended for women with no data indicating risk.
It seems a big part of the argument against testing rather sneakily stated is that incompetent or unethical care is a reason to avoid screening. I seriously doubt that many women have had unnecessary biopsies or worse as a result of screening. Though everyone should know that you always get a second opinion in serious medical situations. Just as you should get three bids on a kitchen remodel.
This CDC website is quite interesting and may allow some to feel they have a better idea re their personal situation statistically speaking, others probably not.
http://www.cdc.gov/cancer/breast/statistics/state.htm
If one reads the entire article the consensus summation is that each women's particular situation in consultation with her physician should dictate the screening level. One might ask why these recommendations are made especially when there is little consensus among the experts.
So if you are Ashkenazi living in Marin County or along the Columbia River or other breast cancer hot spots, or you have a family history the report is not relevant. It is intended for women with no data indicating risk.
It seems a big part of the argument against testing rather sneakily stated is that incompetent or unethical care is a reason to avoid screening. I seriously doubt that many women have had unnecessary biopsies or worse as a result of screening. Though everyone should know that you always get a second opinion in serious medical situations. Just as you should get three bids on a kitchen remodel.
This CDC website is quite interesting and may allow some to feel they have a better idea re their personal situation statistically speaking, others probably not.
http://www.cdc.gov/cancer/breast/statistics/state.htm
2
While the rollback of mammograms makes sense, I am surprised at the recommendation to stop manual exams.
The world's largest study (performed in Canada and published in the British Medical Journal ( http://www.bmj.com/content/348/bmj.g366 ) showed that manual exams were just as good at diagnosing breast cancer as mammograms, and less likely to result in over-diagnosis and unnecessary invasive surgery.
I decided a while ago (after just one painful mammogram) that I would never have another one, unless a specific need was indicated. I stick to my (painless and just as useful) annual breast exams.
I should add, that I have no family history of breast cancer, so my approach is not necessarily the right approach for someone with a family history, or dna results suggesting that she is at risk.
The world's largest study (performed in Canada and published in the British Medical Journal ( http://www.bmj.com/content/348/bmj.g366 ) showed that manual exams were just as good at diagnosing breast cancer as mammograms, and less likely to result in over-diagnosis and unnecessary invasive surgery.
I decided a while ago (after just one painful mammogram) that I would never have another one, unless a specific need was indicated. I stick to my (painless and just as useful) annual breast exams.
I should add, that I have no family history of breast cancer, so my approach is not necessarily the right approach for someone with a family history, or dna results suggesting that she is at risk.
3
When will people realize that the American Cancer Society has never made any significant contribution to the cure of cancer and exists primarily to guarantee it's own existence and the massive amounts of money it raises for it's own benefit.
11
I have never gone for a mammogram despite the reminders from my "health insurance" to go. I do not trust the medical establishment to do the right thing if I were to have a questionable mammogram. I do not trust my health insurance company to cover whatever costs it's supposed to cover without giving me a hard time. And last of all, I don't have the money or the time to take care of myself no matter what illness or treatment I need. We live in a country that does not care about the needs of its citizens, old, young, healthy, handicapped, ill, or otherwise. We have a wealth care system in this country along with a system that serves to alienate us from the help or the personnel that might help us. I have watched too many people suffer from the consequences of a wealth care system that, like our politicians, exists in an alternative universe that does not include reality. Reality in America is that very few people can afford the premiums, the co-pays, the deductibles, and the energy required to fight with the insurance companies, the hospitals, the doctors, etc., when claims are denied just to be denied.
People, all people, ought to be able to receive the medical care that is appropriate for their history and their conditions; not what the wealth care industry allows them to afford or the insurance companies decide is the average never to be deviated from.
People, all people, ought to be able to receive the medical care that is appropriate for their history and their conditions; not what the wealth care industry allows them to afford or the insurance companies decide is the average never to be deviated from.
7
So much money and attention is spent on mammograms when what we really need is to prevent breast and other cancers by fighting for a cleaner environment and using fewer toxic chemicals in our daily lives.
6
QUESTION Of the 231,840 new cases of invasive breast cancer and 40,290 deaths predicted this year, how many fewer or more people in each age cohort will suffer from invasive breast cancer?
How many women with false positives for invasive breast cancer will have been unnecessarily traumatized by an incorrect diagnosis?
The day when a genomic study of women's breast tissue is economical enough to diagnose cancer more accurately will signal a turning point in the fight against breast cancer.
Until then, if you got tested and didn't need it, it's stressful. If you did not get tested and needed it, then died from cancer, is the stress worthwhile?
How many women with false positives for invasive breast cancer will have been unnecessarily traumatized by an incorrect diagnosis?
The day when a genomic study of women's breast tissue is economical enough to diagnose cancer more accurately will signal a turning point in the fight against breast cancer.
Until then, if you got tested and didn't need it, it's stressful. If you did not get tested and needed it, then died from cancer, is the stress worthwhile?
3
My breast cancer materialized at 62, my sister's at 64! Who can say not to have mammograms so early, or never, or late! My daughter-in-law's -- a thin, small woman's was detected at 34!
7
At this point, I don't even trust the findings of cancer. Who is going to say after surgery, whoopsie, my bad, wasn't really cancer.
1
Then get a second, third, and fourth opinion. Rival medical institutions live to point out what the other one did wrong.
In Australia they never do a mastectomy without a confirming biopsy first. If in the early stages with no spread, they will do a lumpectomy.
It's not, 'Oh, might be cancer, let's have that breast off". It has to be properly diagnosed before even considering surgery. I don't know how it is in the states, but our doctors here are more conservative it would seem. Mammograms start at 50 unless one has a family history of it and are done every two years not every year.
It's not, 'Oh, might be cancer, let's have that breast off". It has to be properly diagnosed before even considering surgery. I don't know how it is in the states, but our doctors here are more conservative it would seem. Mammograms start at 50 unless one has a family history of it and are done every two years not every year.
1
While there are a number of intelligent comments here, it's surprising that so many N.Y. Times readers confuse anecdotes with data.
16
Anecdotes, or case studies, certainly are data. They just aren't helpful data in statistical studies of large populations.
While anecdotes alone are inadequate as a basis for making sound public policy, statistical studies may have limited value for an individual. If I happen to be the statistical outlier diagnosed with breast cancer at a young age, the statistical prediction that I would be very unlikely to get it didn't help me much.
While anecdotes alone are inadequate as a basis for making sound public policy, statistical studies may have limited value for an individual. If I happen to be the statistical outlier diagnosed with breast cancer at a young age, the statistical prediction that I would be very unlikely to get it didn't help me much.
3
My breast cancer is not an anecdote to me.
3
Women's lives matter! Get your mammogram (digital if you have access, to minimize exposure) starting early if you are in a higher risk group. Breast cancer occurring in younger women is much more aggressive, timely diagnosis and treatment are essential.
The findings reported here are based on data from 60s, 70s, 80s where digital mammography (using far less radiation) was not in use.
The findings reported here are based on data from 60s, 70s, 80s where digital mammography (using far less radiation) was not in use.
4
Too much of a good thing is always bad. The number of positives to the total number of mammograms done indicates how unnecessary most of them are. That resulting in unnecessary biopsies, needle biopsy, lumpectomy, mastectomy with lymph node dissection, chemo, radiation. The goal should be targeted mammography ( like a family history or estrogen sensitive breast cancer )with fewer false positives so that there is no spiral of painful, disfiguring, mentally distressing treatment. And the bottom line - cut medical costs.
3
Some truths are eternal and just keep coming around: Life's unpredictable. Bad things happen to good people for no reason. It all comes down to luck. And we're all going to die, many of us not in the way (or moment) we'd choose.
I had plenty of time to think about those truths when felled by aggressive breast cancer (with aggressive treatment) at age 42. Made my peace with death but surprised myself by living. To be honest, I think it's a 50-50 thing as to whether prolonged life is worth it: read a good book and it's "yes;" follow politics and it's "no."
What's happening in the U.S. is the dis-mantling of illusions of safety: a generation back, we trusted government more, trusted our employers, trusted churches, schools, doctors and insurers. Who do we trust now? Maybe we weren't really safer, but we thought we were. Those comfortable illusions were priceless to us... but they were just illusions.
As far as mammograms: whether you find a feeling of safety in more testing, or less, is very personal and not scientific. They don't really deliver life or death, either, because you could still be hit by a bus!
Better focus one's energy on living fully, loving others, making peace with death (it's inevitable), accepting limitations, and having enough fun that your last thought can be, "this was a perfect day."
I had plenty of time to think about those truths when felled by aggressive breast cancer (with aggressive treatment) at age 42. Made my peace with death but surprised myself by living. To be honest, I think it's a 50-50 thing as to whether prolonged life is worth it: read a good book and it's "yes;" follow politics and it's "no."
What's happening in the U.S. is the dis-mantling of illusions of safety: a generation back, we trusted government more, trusted our employers, trusted churches, schools, doctors and insurers. Who do we trust now? Maybe we weren't really safer, but we thought we were. Those comfortable illusions were priceless to us... but they were just illusions.
As far as mammograms: whether you find a feeling of safety in more testing, or less, is very personal and not scientific. They don't really deliver life or death, either, because you could still be hit by a bus!
Better focus one's energy on living fully, loving others, making peace with death (it's inevitable), accepting limitations, and having enough fun that your last thought can be, "this was a perfect day."
13
ACS needs to articulate this WAY BETTER!!!
3
We now know that cancers are a set of highly variable and complex diseases; they do not always progress in a linear and rapid fashion of: Start small, grow larger, metastasize, result in death, which is the basis for early detection. Some cancers have already metastasized by the time they are discovered, even if at a small stage; others are so slow growing that they would never have caused a problem in the patient's life time; and others grow and then regress, not necessarily due to treatment. If the old linear model was correct, then screening for and treating smaller and smaller breast cancers should result in a concomitant decrease in death from breast cancer, but that's not the case. More and more little cancers are being diagnosed, but the death rate is not going down at the same rate. For DCIS, it appears that treatments have very little if any effect on overall survival. And the problem is that treatments cause harm: e.g., radiation increases risk of angiosarcoma and leukemias (fatal); tamoxifen increases risk of uterine cancer and blood clots (fatal); etc. We need better screening methods; mammography appears to result in a lot of harm for very little benefit.
9
You're an excellent writer. Thanks for posting this.
Why would I listen to national guidelines about my breast care, and not think for myself with the help of progressive MDs? Mine suggested bypassing the mammo in favor only of the sonogram. My experience in MN has been (1) an extra charge if I want a breast exam at the time of a mammo; and (2) in spite of the fact that my mother had breast cancer and that I have density, the hospital breast center refused to honor my doctor's prescription for a sonogram. I requested to see the radiologist, and my request finally was honored. The tech division determined--based on population studies (?) --that I didn't deserve a sonogram. Really, leave my fate to the industry? I don't think so. Why isn't anyone talking about sonograms. And what about digital? The issue of detection doesn't rest with the mammogram.
5
Most of the scientific evidence about this topic is statistical. Unfortunately, that's how it is right now.
It's the same way with earthquakes. It would be great to be able to predict individual earthquakes, but we can't yet do that.
Similarly, we can't tell in individual cases whether a woman will have a non-normal mammogram unless she actually has a mammogram, or whether a small cancer detected will become aggressive and life-threatening or will not, or whether re-testing after an ambiguous mammogram will yield an alarming finding or whether it'll be negative except for producing painful side effects.
Of course everyone feels like this: "I don't want to hear statistics; tell me what will happen to me." It's an uncomfortable truth that doctors can't do this yet. The fact that the evidence is statistical is mirrored in the range of anecdotes here, like "mammography saved my life" "waiting too long for mammograms killed my relative" versus "these invasive after-mammogram procedures disabled me" and "I've never had a mammogram and I'm perfectly healthy."
It's good to explain to the public what the statistics suggest is most likely. It is also good to explain, though distressing to hear, that the state of medical knowledge cannot tell an asymptomatic individual "this is best for sure." We all have to play the odds, in this as in many aspects of life.
It's the same way with earthquakes. It would be great to be able to predict individual earthquakes, but we can't yet do that.
Similarly, we can't tell in individual cases whether a woman will have a non-normal mammogram unless she actually has a mammogram, or whether a small cancer detected will become aggressive and life-threatening or will not, or whether re-testing after an ambiguous mammogram will yield an alarming finding or whether it'll be negative except for producing painful side effects.
Of course everyone feels like this: "I don't want to hear statistics; tell me what will happen to me." It's an uncomfortable truth that doctors can't do this yet. The fact that the evidence is statistical is mirrored in the range of anecdotes here, like "mammography saved my life" "waiting too long for mammograms killed my relative" versus "these invasive after-mammogram procedures disabled me" and "I've never had a mammogram and I'm perfectly healthy."
It's good to explain to the public what the statistics suggest is most likely. It is also good to explain, though distressing to hear, that the state of medical knowledge cannot tell an asymptomatic individual "this is best for sure." We all have to play the odds, in this as in many aspects of life.
3
I've known of cases, some reflected in these threads, in which women who have been diagnosed with cancer after having skipped mammograms for several years (or more) then blame themselves, agonizing how it must be that if they had only had mammograms, why, it would all be okay now. The truth is that sometimes an earlier mammogram would've been helpful in the treatment; other times, not at all. My sister had all the mammograms, had her cancer detected as early as conceivably possible, and didn't survive. Others have waited until they felt a lump on self-examination and did. So by all means, get a mammogram if you feel it's right for you. But don't let anybody tell you it's a magic answer to cancer, or that your cancer is your fault.
20
For all of you who are claiming that you wouldn't be alive today had you not had a mammogram, please keep in mind that your individual experience has nothing to do with public policy. When creating a healthcare system for more than one person (you), one must consider what happens to the entire group. This must take into account adverse outcomes from unnecessary treatment, as well as costs. So, while *your* life may have been saved by a mammogram, how many lives were lost as a result of your early screening? These deaths may be due to complications from unnecessary treatment (due to false positives and/or tumors that never needed treating in the first place), radiation from the screening itself, or money that did not go to cover, say, immunizations and other preventive care that could save many more lives.
15
Also keep in mind that many of those cancers are slow cancers that would have been discovered by manual exams in good time even without a mammogram.
1
Some would say we do not need the federal government running (ruining?) health care. The costs of Obamacare are exploding. Every sane person knew this but some were and are so invested in the political they won't even see what is in front of their cases. This is what the rationing of care looks like. It isn't between you and your doctor anymore.
Let's get some numbers. According to a recent American Cancer Society publication, in 2013, among American women under age 40, there were 10,980 new cases of invasive breast cancer and 1,020 deaths from breast cancer. In women under age 50, there were 48,910 new cases of invasive breast cancer and 4,710 deaths. (Numbers for women under age 45 are not given, but we might guess 2,000 deaths for that age group.)
http://www.cancer.org/acs/groups/content/@research/documents/document/ac...
So, the ACS is saying that mammograms aren't worth doing for women under 45 because they are too imperfect to make much difference in saving lives among this relatively small percentage of the population. The benefits aren't worth the costs in light of time and expense as well as false positives that incur further testing and worry for much larger numbers of women.
As a long-term survivor of Stage 2 invasive breast cancer diagnosed when I was 44, this is emotionally hard for me to take, but I understand the logic.
More difficult to understand is the statement reported in this news story that clinical breast exams by doctors or nurses aren't worth doing for women of any age, because there is "no evidence" that they have saved lives. Yet the same ACS publication says that most breast cancers are discovered by women who feel a lump in their breast. Surely doctors and nurses sometimes detect a cancerous breast lump too.
http://www.cancer.org/acs/groups/content/@research/documents/document/ac...
So, the ACS is saying that mammograms aren't worth doing for women under 45 because they are too imperfect to make much difference in saving lives among this relatively small percentage of the population. The benefits aren't worth the costs in light of time and expense as well as false positives that incur further testing and worry for much larger numbers of women.
As a long-term survivor of Stage 2 invasive breast cancer diagnosed when I was 44, this is emotionally hard for me to take, but I understand the logic.
More difficult to understand is the statement reported in this news story that clinical breast exams by doctors or nurses aren't worth doing for women of any age, because there is "no evidence" that they have saved lives. Yet the same ACS publication says that most breast cancers are discovered by women who feel a lump in their breast. Surely doctors and nurses sometimes detect a cancerous breast lump too.
6
Perhaps our self-exams are supposed to replace the clinical ones. But having the clinical ones taught me how to do my own at home. Hm.
Welcome to Onamacare and healthcare rationing. Frequent and early testing is just too expensive folks. The American Cancer Society has sold out. It is sickening to think how many women will now die due to this horrible and irresponsible decision. Talk about a war on women and their health!!!
8
Except that other developed countries, ones not affected by U.S. health care debates or laws, have already gone in this direction because they followed the research.
5
Perfectly reasonable, like many guidelines from august organizations - unless, of course being a human being and not a mass produced brake pad, you are the one who falls outside of the statistics so beloved by all such groups!
As a practicing physician for more than 40 years, I told my patients that such guidelines are just that - suggestions, not orders.
The patient needs to be informed, and make his or her own decision, based on the best information available.
As a practicing physician for more than 40 years, I told my patients that such guidelines are just that - suggestions, not orders.
The patient needs to be informed, and make his or her own decision, based on the best information available.
10
As a breast cancer survivor I disagree with the American Cancer Society recommendations. If I had followed their guidelines the breast cancer I had in 2005 would have been more advanced and chemotherapy might have necessary. When I returned for my annual mammogram the year after I was treated I was sitting with 8 other women in the waiting room. It turned out that all of us has had breast cancer in 2005 and that none of us had had chemo due to early detection.
I reply on the judgement of my Radiologist
I reply on the judgement of my Radiologist
4
How do you know that?
2
I know there are false positives. I know mammograms can lead to unnecessary biopsies. And I think there has to be a way to fix all that -- but it seems to me that doing more to fix the technology is the way to go instead of just giving up on screening--especially clinical breast exams. I was diagnosed when I was 43. The cancer was already screwing around with my lymph nodes. I had nine months of treatment and, seven months later, I'm doing great. I would much rather have dealt with the chance of a false positive than given my cancer two more years to grow before I had a mammogram.
6
But the imaging centers won't make as much money if women don't get annual mammograms. The ACS must be biased against business.
4
This is all fine, but you must accept that there will be an occasional young woman who will develop an aggressive cancer between intervals of mammography and by the time of diagnosis the cancer will be metastatic and fatal. The question is whether an earlier diagnosis would have resulted in a possible cure or whether such a cancer, at the time of diagnosis, is already micrometastatic and probably fatal. While the latter is probably the correct interpretation, many such women will sadly believe the former and feel that this recommendation doomed them.
1
The tumors that kill young women tend to grow very quickly, so even yearly mammograms may not catch them. Some of this comes down to luck, unfortunately.
What I find more perplexing than this article are the various comments by some readers who offer unsolicited medical advise based on their personal research. Whatever decision/path a woman takes which she feels will benefit her life should be respected instead of brought into question or judgment. Even the medical staff at the ACS have varying opinions as to which road would be most beneficial for women to take. Frankly, it's a personal decision and although many of the comments have been informative and thought provoking, there is still a fine line between offering suggestions and research-related information and giving unsolicited advise. Some of the comments come across as cold, harsh and judgmental.
3
If I had waited until 45 I'd be dead. A mammogram discovered a tumor at 42 after having had a physical. After a year of treatment (lumpectomy, chemo and radiation) it recurred when I was 47. After a mastectomy it recurred when I was 51 on my upper chest. Since that last intense round of radiation I've been fine. Hate to consider the alternative.
6
In 1962 my mother had breast cancer at 32, young for breast cancer no mammogram to diagnose, she had a mastectomy 10 days after the lump was found, in that short time the cancer metastasized to other areas of the breast and a more radical surgery was needed. She survived, having radiation and a hysterectomy. I had breast cancer in 1986 at age 39, a mammogram was done after finding the lump, after talking with the surgeon I had a full mastectomy and lucky for me it was small with no spread to the lymph nodes and no other treatment. I've done well with annual breast exams and mammograms. I know what the American Cancer Society says about this but I still advocate for mammograms, early. We both had good doctors that didn't send us on our way with a wait and see if it's there in 6 months diagnosis. Earlier detection is a must. If a mammogram is a tool in toolbox I say use it.
20
The article clearly states this recommendation does not apply to those with a family history of breast cancer, or any other known risk factors for that matter. I agree that in your case that you did the right thing in having an early mammogram, as would anyone else with such a family history.
5
This just in. Stop listening to these financial rip off money hungry quacks that make up America's health system and only get procedures, tests, appts. etc when they are been proven of value over time.
5
This is old news in most other rational countries. Mammograms are done too early and too often. Remember when the American Cancer Society changed the recommendation to start at 40 instead of 35? There are STILL paleozoic doctors out there recommending them starting at age 35.
When looking at different guidelines, follow the money. The ACS is in the business of selling cancer awareness and fear, so it tends to drag its feet well behind the scientific data. The American College of Ob-Gyn (ACOG), funded by ob-gyn physicians, still recommends that asymptomatic patients see a doctor once a year. Since paps are now recommended only every 3-5 years, the yearly breast exam was their last hope to justify unnecessary yearly visits and preserve income for ob-gyn physicians.
If someone showed me evidence that I only needed colonoscopy every 20 years instead of every 10 years, I would say that is a great relief. Why the persistent whining about fewer mammograms?
When looking at different guidelines, follow the money. The ACS is in the business of selling cancer awareness and fear, so it tends to drag its feet well behind the scientific data. The American College of Ob-Gyn (ACOG), funded by ob-gyn physicians, still recommends that asymptomatic patients see a doctor once a year. Since paps are now recommended only every 3-5 years, the yearly breast exam was their last hope to justify unnecessary yearly visits and preserve income for ob-gyn physicians.
If someone showed me evidence that I only needed colonoscopy every 20 years instead of every 10 years, I would say that is a great relief. Why the persistent whining about fewer mammograms?
3
I suggest you ask a female acquaintance who's had breast cancer, preferably one diagnosed because of mammography, about the "whining." And then go have a nice big cup of ......compassion.
2
Nearly 10 years ago, my younger sister's breast cancer was discovered on her first ever mammogram, when she had turned 40. She had no masses, no lumps, no symptoms. At that point, we had no history of breast cancer in the family, and no none had ever undergone genetic testing to determine BRCA status. Had she waited until she was 45 to get a mammogram, I suppose it's possible her cancer would not have progressed to far, and she would have survived; it's also possible she would not have survived.
Five years after my sister's diagnosis, I was diagnosed with breast cancer, just before my 50th birthday; the result of a routine annual mammogram; I had been having annual mammograms since I turned 40, all of which were normal.
In just 14 months, from the time of my last normal mammogram, to the one that detected breast cancer, the cancer had progressed into all my axillary lymph nodes under the left arm. I had no masses, no lumps, no symptoms. My breast cancer was staged at 3C - just a step away from Stage 4. That was nearly 5 years ago.
Given the choice of discovering breast cancer too late, or having a 'false positive' on a mammo, and undergoing a biopsy that is determined to be 'benign' or 'non-cancerous', I'd opt for the 'needless' worry of the latter scenario. My vote is for annual mammos starting at age 40 for the general population, and for those with a family history and/or the BRCA mutation, perhaps earlier.
Five years after my sister's diagnosis, I was diagnosed with breast cancer, just before my 50th birthday; the result of a routine annual mammogram; I had been having annual mammograms since I turned 40, all of which were normal.
In just 14 months, from the time of my last normal mammogram, to the one that detected breast cancer, the cancer had progressed into all my axillary lymph nodes under the left arm. I had no masses, no lumps, no symptoms. My breast cancer was staged at 3C - just a step away from Stage 4. That was nearly 5 years ago.
Given the choice of discovering breast cancer too late, or having a 'false positive' on a mammo, and undergoing a biopsy that is determined to be 'benign' or 'non-cancerous', I'd opt for the 'needless' worry of the latter scenario. My vote is for annual mammos starting at age 40 for the general population, and for those with a family history and/or the BRCA mutation, perhaps earlier.
10
Women's screening choices will no doubt be strongly influenced by what their insurance covers. It baffles me that women who know (usually from a first mammo) that their breast density is such that mammograms are unhelpful cannot simply do sonograms instead (and save on the radiation dose, bonus!). Making women take the x-rays before they can get a sono that might actually tell them something is ridiculous.
10
Other comments have already mentioned this, but it is worth repeating ...
Mammograms can cause cancer. All X-rays pose cancer risk.
The risk is small, but mammograms in cases where they are unlikely to help (based on age and other risk factors) will result in a small number of cancers that would not have occurred otherwise.
Mammograms can cause cancer. All X-rays pose cancer risk.
The risk is small, but mammograms in cases where they are unlikely to help (based on age and other risk factors) will result in a small number of cancers that would not have occurred otherwise.
21
Did everyone know that "radionuclides" from past atomic testing, nuclear meltdowns like Chernobyl and Fukushima, and radiation released from nuclear power plants are linked to breast cancer?
These "radionuclides" are now in our air, water, food, rain, snow, etc.
And now the U.S. nuclear industry is considering RAISING the radiation exposure amounts for women, pregnant women, and children...AND allowing everyone in the U.S. to receive as much radiation as a nuclear worker!
Please tell them NO, you do not consent to more radiation exposure for yourselves and your family -->
www.change.org/p/united-states-nuclear-regulatory-commission-protect-chi...
These "radionuclides" are now in our air, water, food, rain, snow, etc.
And now the U.S. nuclear industry is considering RAISING the radiation exposure amounts for women, pregnant women, and children...AND allowing everyone in the U.S. to receive as much radiation as a nuclear worker!
Please tell them NO, you do not consent to more radiation exposure for yourselves and your family -->
www.change.org/p/united-states-nuclear-regulatory-commission-protect-chi...
2
MarkH: yes, the risk is small; very, very, very small and mammograms do help some women, whatever the mammography schedule, so let's not let that tiny risk outweigh the great benefit of having a mammogram. Some readers will use the tiny risk of a secondary cancer to persuade themselves not to get a mammogram. Generally speaking, for all diagnostic X-rays, the benefit considerably outweighs the risk.
2
Increased estrogen is linked to breast cancer, which is why child bearing and breast feeding (for 1-2 years) are beneficial in combatting breast cancer. They both suppress, for a time, the production of estrogen. It should also be noted that birth control pills contain estrogen, this fact is played down by the medical community, instead of being discussed as a possible negative consequence of taking "the pill".
6
Childbirth isn't risk-free. I know soneone who died in labor.
I'm in my early 60s. For years I had regular mammograms that showed no problems. Then I moved to my current location 9 years ago. Since then I have been called back for closer examinations every single year except one. Never has anything been found. Last time they found nothing after a sonogram but wanted me to come back every 6 months.
I'm beginning to think it's a racket.
I'm beginning to think it's a racket.
59
Hard to say. It may very well be to take advantage of what the insurance company will pay.
Because of an early lumpectomy in my 20's, I've been advised to have annual mammos and ultrasounds by my breast surgeon. In the last 15 years, I've had three biopsies, one for which they left a marker inside me to help them find the location for surgery they suspected I needed. All have been benign.
I'm getting a lot of radiation but I have to admit I am comforted by the results. Since I'm now in that slow-growing stage, I'm going to discuss with my breast surgeon when I see him.
Because of an early lumpectomy in my 20's, I've been advised to have annual mammos and ultrasounds by my breast surgeon. In the last 15 years, I've had three biopsies, one for which they left a marker inside me to help them find the location for surgery they suspected I needed. All have been benign.
I'm getting a lot of radiation but I have to admit I am comforted by the results. Since I'm now in that slow-growing stage, I'm going to discuss with my breast surgeon when I see him.
1
It is a racket. And the American Cancer Society perpetuates disinformation about cancer all the time. They fired the researcher who did a huge study of people with and without cancer and discovered that beef and dairy are major causes of inflammation and cancer. Some of us radicals saw through the lies about cancer and diet in the early 70s. I am 62 and have had two mammograms. I got called back for a sonogram, too. Then I switched to Thermograms. A completely safe procedure. Same with Pap smears. What a racket. My OB/GYN completely supports my view. The AMC doesn't want people to eat healthy and avoid cancer; it rather profit from the drugs that often kill people.
I'm with you on this.
1
The pushback to less mammograms is coming from hospitals and insurance companies. Billable procedures are budgeted revenue sources, and "healthcare providers" and their insurance company cohorts do not want revenue sources affected by evolving medical reality.
6
Sometimes recommendations don't matter.
When I was 40 I had my first mammogram. After the initial mammogram, the radiologist requested more slides to get a better look at some spots that were visible in the first slides. Still not being clear in the second set of slides, the radiologist requested an ultrasound. After the ultrasound I was informed that the there were no malignancies in my breasts. I was told that because I have dense breast tissue I am considered "at risk" for cancer and that I should get yearly screenings.
Then I got the bill for the additional slides and for the ultrasound. My insurance company covered the initial mammogram, but it considered the extra slides and the ultrasound separate medical procedures that I was responsible for.
While I was gainfully employed at the time, the surprise bill for $600 was a shock, and it was really difficult pay. I avoided mammograms for several years after that even though I was considered "at risk."
The recommendations by the ACS were a moot point because I couldn't afford the additional diagnostic procedures.
By the way, it was considerably more upsetting to not be able to afford preventative care than it was to get a false positive.
When I was 40 I had my first mammogram. After the initial mammogram, the radiologist requested more slides to get a better look at some spots that were visible in the first slides. Still not being clear in the second set of slides, the radiologist requested an ultrasound. After the ultrasound I was informed that the there were no malignancies in my breasts. I was told that because I have dense breast tissue I am considered "at risk" for cancer and that I should get yearly screenings.
Then I got the bill for the additional slides and for the ultrasound. My insurance company covered the initial mammogram, but it considered the extra slides and the ultrasound separate medical procedures that I was responsible for.
While I was gainfully employed at the time, the surprise bill for $600 was a shock, and it was really difficult pay. I avoided mammograms for several years after that even though I was considered "at risk."
The recommendations by the ACS were a moot point because I couldn't afford the additional diagnostic procedures.
By the way, it was considerably more upsetting to not be able to afford preventative care than it was to get a false positive.
12
Why didn't you contact your insurer and inquire about coverage before you had the additional exams? Sounds to me like you created the situation-not the insurance co.
1
As j.r. says, treat the insurance company and the medical providers as people who will indeed rip you off if you're not careful. They will not advise you of anything about money before you do as instructed; you have to chase them down and insist on knowing what the costs will be. And even then, you will often find that those estimates are only a fraction of what you're later billed.
Not doing this, not understanding the adversarial nature of our medical system to patients, is then going to be said to be "your own fault", as j.r. so clearly also demonstrates.
Not doing this, not understanding the adversarial nature of our medical system to patients, is then going to be said to be "your own fault", as j.r. so clearly also demonstrates.
1
It's confusing because to you it's one visit to one place for one health issue, but it's several items to the insurer.
With my insurer, mammas and ultrasounds are definitely separate procedures for which you will need separate referrals (I also learned the hard way). In fact, if you have to go back and get an image redone, that requires a separate referral as well.
When I have problems, I write to our State Insurance Commissioner. Once the rules changed the next year after I wrote about the insurer's unethical referral policy. I like to believe I had an impact, although it might have just been coincidence.
With my insurer, mammas and ultrasounds are definitely separate procedures for which you will need separate referrals (I also learned the hard way). In fact, if you have to go back and get an image redone, that requires a separate referral as well.
When I have problems, I write to our State Insurance Commissioner. Once the rules changed the next year after I wrote about the insurer's unethical referral policy. I like to believe I had an impact, although it might have just been coincidence.
3
Lots of people earn a good living giving and analyzing mammograms and in providing biopsies etc. for those identified as positive. If people start later and have fewer mammograms, many of these workers will be out of a job. Who is going to pay to retrain them? While the tests might not be useful to the patient, as long as the insurance companies and Medicaid pay for them, it's a jobs program and the people doing this work don't have an easy path to more useful work.
1
So women should keep getting mammograms to keep technicians and health-insurance company workers employed?
A better solution would be to use the extra money to expand health care to 100% of the population. Many people out there are dying of diseases that would be perfectly treatable if they only had health insurance. That way, no one would have to be unemployed, and fewer people would die.
A better solution would be to use the extra money to expand health care to 100% of the population. Many people out there are dying of diseases that would be perfectly treatable if they only had health insurance. That way, no one would have to be unemployed, and fewer people would die.
4
I am a practicing medical oncologist who sees breast cancer patients (and DCIS patients) on a daily basis. I see a number of people here discussing increasing breast cancer incidence in younger populations over the last two or three decades and suggesting that this should be a rationale for earlier mammograms. Have a look at rifotay's comment below for an explanation of why we don't screen everyone for breast cancer from the time they are born to the time they die. As far as the increased incidence for younger folks, the most obvious and apparent reason for this is improved screening techniques and increased use of screening. 30 years ago, virtually no one was having breast cancer screening done in their 30's, and very few in their 40's. They would discover their cancer by noticing something different in their breast contour or feeling a lump. In the meantime, hundreds of thousands of these women had either remotely small tumors that would be detectable by mammogram but that also have a very low chance of becoming invasive/cancerous, or had fibroadenomas or other benign histologies that still constituted a "positive" mammogram.
In addition to this, consider that obesity (leading to increased estrogen) is an independent risk factor for development of breast cancer, regardless of age.
On top of that, consider also that cancer is a much more public disease than it was in the 80's and even 90's.
In addition to this, consider that obesity (leading to increased estrogen) is an independent risk factor for development of breast cancer, regardless of age.
On top of that, consider also that cancer is a much more public disease than it was in the 80's and even 90's.
26
You thought you were confused about mammograms before? Now the American Cancer Society has revised its guidelines, saying most women can start at age 45. The guidance still doesn't match what has been suggested by other groups and is sure to raise more controversy.
There's big disagreement over when and how often women should get mammograms. Until today, the American Cancer Society said women should get one every year starting at age 40, as well as regular breast exams by their doctors.
The new American Cancer Society guidelines are far more complicated. They say women of average risk of breast cancer can wait until they're 45 to have a first mammogram and should have them every year until age 55, and then start having them every other year.
This is a little closer to the U.S. Preventive Services Task Force recommendations that most women can safely wait until they are 50 to start getting mammograms, and that they only need one every other year.
Still, what's most important, all groups agree, is for a woman to talk about her risk with her doctor, and decide what she's most comfortable doing.
There's big disagreement over when and how often women should get mammograms. Until today, the American Cancer Society said women should get one every year starting at age 40, as well as regular breast exams by their doctors.
The new American Cancer Society guidelines are far more complicated. They say women of average risk of breast cancer can wait until they're 45 to have a first mammogram and should have them every year until age 55, and then start having them every other year.
This is a little closer to the U.S. Preventive Services Task Force recommendations that most women can safely wait until they are 50 to start getting mammograms, and that they only need one every other year.
Still, what's most important, all groups agree, is for a woman to talk about her risk with her doctor, and decide what she's most comfortable doing.
3
As my medical decisions remain, this is between me and my nurse practitioner and doctors. The ACS has issued GUIDELINES that are neither rules nor laws. In NYS women can get mammograms when they have dense breast tissue. This regulation is allowed due in part to the advocacy of a friend of mine who was diagnosed with Stage 4 because the cancer was obscured by tissue and hidden from mammography. She died last year, after NYS signed this into law. If it gives me piece of mind I'll get a mammogram. If my gut tells me there's something there I'll have ultrasound done. These are my decisions and I'll pay for them one way or another.
7
Interesting about "gut" checks. I asked the doctor doing my breast biopsy if women could tell (ex., had a "feeling" or "sense" that something was wrong) before they received their cancer diagnoses. His response was, "No."
1
I was 44 when diagnosed with Stage 2 invasive infiltrating adenocarcinoma (triple neg). Recurred at age 46. If I had not had a mammogram, I would probably be dead today. Furthermore, the large majority of breast cancers are in women with no family history! That is a proven statistic. I had no history on either side of my family. I just wonder who paid off the American Cancer Society to come up with this decision? Is it to save money over saving lives? Sadly, I fear that is the case. Shame on you, ACS! I will no longer be donating to your cause. You have sold out to the pressure of the government. P.S.-Most of the women in my breast cancer survivor group were below the age of 45. What say you now??
11
Here's the thing (and the article doesn't make this clear so it's no wonder that there's such confusion). The studies are showing that whether you discovered the cancer through the mammogram...or found it naturally at a later stage....that your survival rate would have been much the same.
In addition, there's a good chance that the early cancer you found in the mammogram would never have grown any larger and that perhaps you went through treatment that wasn't necessary.
Going forward, women who feel more comfortable having the tests should do so. But its also reassuring to know that women who don't have these procedures are also likely to have similar outcomes (good or bad).
In addition, there's a good chance that the early cancer you found in the mammogram would never have grown any larger and that perhaps you went through treatment that wasn't necessary.
Going forward, women who feel more comfortable having the tests should do so. But its also reassuring to know that women who don't have these procedures are also likely to have similar outcomes (good or bad).
2
You are confusing individual outcomes with population-based outcomes.
3
What we are seeing is the gradual change in policy by professional organizations as new data becomes available. Science is by no means exact and most scientists are willing to change their views when data changes. There has been argument in the medical world for a number of years regarding the utility of mammography. The argument is not whether or not mammograms find breast cancer early, but rather is it early enough to make a meaningful difference in a woman's life. This argument will continue for some time. The ACS's guidance essentially says that when two experts conflict in their recommendations, go with the one that you want to.
The more interesting public policy question regarding screening in general is that: even if it works, is the financial cost to society worth the price? Also, how much unintended harm that is done to individuals who falsely test positive for a disease is society going to accept?
The more interesting public policy question regarding screening in general is that: even if it works, is the financial cost to society worth the price? Also, how much unintended harm that is done to individuals who falsely test positive for a disease is society going to accept?
2
As a breast cancer survivor, I can state unequivocally that the stress of additional testing is nothing compared to being told you have cancer. The fact is this - cancer has to be diagnosed and typed before any treatment plan can be initiated. Just how does this get done if the basic diagnostic tool is being denied simply because someone somewhere thinks cancer can't happen to younger women? Or is "too rare" for screening to be cost effective? How about if the male physicians who advocate this forego their own PSAS and "turn your head and cough" exams?
Regardless, women can and should continue to regularly check their own breasts for any lumps or changes in density. That costs nothing nor requires an appointment. ;-)
10
Sorry, but by the time you feel a lump you're already in trouble.
I am 46 yo. Two years ago, I had a conversation with my ob-gyn at my annual exam about decreasing the number of mammograms. She stood firm with her recommendation, which was to have a mammogram annually (I have no history of breast cancer). Because doctors these days must practice medicine in a defensive way, with an eye to litigation, I suspect my doctor will not change her recommendation until the industry group representing ob-gyns issues new guidance. In the meantime, this is a good step in the right direction. I am, however, perplexed by the recommendation to do away with regular clinical breast exams. I don't understand the reasoning behind it and the article did not address this.
10
A large number of doctors now have financial ties to the facilities that do testing and procedures. In my state, such doctors are required to tell patients that as part of a form before testing; you might be sure to read your forms carefully.
And for us guys, prostate screenings should be considered as unnecessary and costly, with little benefit to quality of life.
7
It may be difficult to hear this--but surely women with very aggressive, early-onset cancers are significantly different from women with pre-cancers formerly classified as cancers, or very indolent tumors, or very small self-contained tumors.
And it is further difficult to accept that some people contract virulent disease that cannot be cured, regardless of the aggressiveness of treatment; some people will have inexplicable remissions regardless of treatment or its absence; some people with cancerous cells or small tumors in their bodies would never develop life-threatening cancer without the added stimulus of radiation from mammography; some people with those cancerous cells or tumors will never develop life-threatening disease but would have their quality of life irrevocably harmed by medical treatment.
And for the most part it*s impossible to figure out who will fit into which category. I certainly don't want to develop cancer. I also certainly do not want my present quality of life destroyed. Am I willing to trade, if it comes to that, a few years of miserably-extended life and die relatively quickly from a very-late-diagnosed cancer? Yes, I am.
And it is further difficult to accept that some people contract virulent disease that cannot be cured, regardless of the aggressiveness of treatment; some people will have inexplicable remissions regardless of treatment or its absence; some people with cancerous cells or small tumors in their bodies would never develop life-threatening cancer without the added stimulus of radiation from mammography; some people with those cancerous cells or tumors will never develop life-threatening disease but would have their quality of life irrevocably harmed by medical treatment.
And for the most part it*s impossible to figure out who will fit into which category. I certainly don't want to develop cancer. I also certainly do not want my present quality of life destroyed. Am I willing to trade, if it comes to that, a few years of miserably-extended life and die relatively quickly from a very-late-diagnosed cancer? Yes, I am.
14
That's fine for you. But not everyone feels the same way.
I'm with you, SCA.
Others are free to make their own choices, Keen Observer. SCA didn't say her way is better.
Others are free to make their own choices, Keen Observer. SCA didn't say her way is better.
This is an issue I follow with some interest. More and more real data calls the value of this test into question, and this has been happening for years. None of the data I've seen points to any significant shift at 45 in the usefulness of the mammograms, so I bet that was a compromise position reached by the committee just because it needed to come to a compromise. We'll know there's been real progress toward better thinking about PREVENTION when organizations like this devote more energy to getting the word out about all the things that women can do to truly cut their risk -- regular exercise, not gaining weight through middle age (and those are separate variables), not drinking, eating lots of cruciferous vegetables, etc. And if you're convinced that you need a mammogram or else your life is in danger, are you attending to all those lifestyle things so that your life really IS in less danger? If not, why not? If you didn't know of them, press for more info about "breast cancer awareness" (who's not aware of breast cancer, anyway?). If you did know about them and just aren't following the advice, stop complaining that this research-based new approach is going to hurt you and realize that YOU are hurting yourself. You are risking your life. At least own it.
3
My best friend is undergoing a lumpectory this morning. Her tumor was found recently on a routine mammogram. I'm not skipping my mammogram this year.
9
Maybe the lumpectomy will have saved your friend's life. The odds, however, are that it will not do anything to lengthen her life and that it will subject her to life altering surgery for nothing. Nothing at all.
8
Lumpectomies aren't usually disfiguring, Kaleberg. Your comment is unnecessarily harsh.
And now can we have someone look at the way many people are sent for repeated ultrasounds and biopsies of their thyroid?? For ten years --- doctors have sent me for thyroid ultrasounds and I've had four biopsies. I've also had a thyroid scan. The ultrasound shows large nodules, the thyroid biopsies come back negative. (Thankfully) STILL it's costly and nerve-wracking to have this repeated. I have no symptoms of thyroid disease nor do I have a goiter == my neck looks normal -- but still -- it appears that thyroid disease has become one of the "flavors of new disease" for which doctors are testing repeatedly. Maybe we need some new guidelines there too.
Plus let's stop testing for Vitamin D deficiency. It's a waste of time and money.
Plus let's stop testing for Vitamin D deficiency. It's a waste of time and money.
3
Actually, Vitamin D deficiency may make breast cancer more likely to develop. A lot of research points in that direction. If that's true, then getting to a healthy Vitamin D level should be considered breast cancer prevention.
Get a new doctor or – better yet – a nurse practitioner.
2
Agree on the thyroid. A real profit center for endocrinologists, and I like mine, but I know that adjacent ultrasound lab is just raking in $10s of thousands each month, at least based on what I see in my billing for an appt. Am careful not to get one of those every time I have to go it ...
Disagree on Vitamin D. Levels are important, and too low can happen so easily to many, with many detrimental effects.
I guess it becomes an individual thing ... knowing one's 'weak spots' and trying to keep up with those areas ...
Disagree on Vitamin D. Levels are important, and too low can happen so easily to many, with many detrimental effects.
I guess it becomes an individual thing ... knowing one's 'weak spots' and trying to keep up with those areas ...
The tone of so many of these replies baffles me. A scientific organization has studied the situation and made a recommendation. That's all, it's what they recommend. If you disagree with what's recommended, have more mammograms.
30
The ACS is not a scientific organization. It is a charitable organization. You can't tell people one thing and then tell them something else several years later. That isn't science. It feels like guesswork.
1
The problem is that insurance may not cover annual mammograms if the recommendation is not to have them at an early age or only every two years for some people.
3
It's more complicated than that. These suggested guidelines are too often used by insurance companies to deny diagnostic testing. If you think paying for yearly mammography is expensive, try paying for a stage 3 patient's treatment.
1
Generally speaking I agree with this change. I'm in my 60's and over the course of my lifetime I've had way fewer mammograms than recommended, probably one every five years.
On the other hand, women are getting breast cancer younger and younger. I blame environmental toxins in the air, food and water. A friend of mine died of breast cancer in 2002 at the age of 39. Her oncologist told her that twenty-five years ago he saw one or two cases of breast cancer a year in women under 30; now they constituted a regular part of his practice. So, do we want to wait until age 45 to have the first mammogram?
And on the other hand, the tests don't work that well so cancer could be missed anyway, or set us up for later cancer, or...
These are the contradictions we live with now. I don't have a quick and ready answer.
On the other hand, women are getting breast cancer younger and younger. I blame environmental toxins in the air, food and water. A friend of mine died of breast cancer in 2002 at the age of 39. Her oncologist told her that twenty-five years ago he saw one or two cases of breast cancer a year in women under 30; now they constituted a regular part of his practice. So, do we want to wait until age 45 to have the first mammogram?
And on the other hand, the tests don't work that well so cancer could be missed anyway, or set us up for later cancer, or...
These are the contradictions we live with now. I don't have a quick and ready answer.
9
The critics who say the new policy is confusing are right, because it is. It's saying don't have mammograms over age 55, but if you want to, go ahead. Wow. That's crystal clear.
I have a lot of cancer in my family, including a final finding in my mother who died before the lump could be biopsied. She was already terminal from metastasized to lung squamous cell oral cancer, so who knows if the new lump was from the metastasis, or a new cancer. Since I've had annual screenings since my late 30s, I intend to continue.
But with several cancer societies contradicting each other, they aren't making it any easier for women to get clear guidance. We're always being told to be our own well-informed advocates regarding patient care, but all I can say is, that's way easier said than done at times.
I have a lot of cancer in my family, including a final finding in my mother who died before the lump could be biopsied. She was already terminal from metastasized to lung squamous cell oral cancer, so who knows if the new lump was from the metastasis, or a new cancer. Since I've had annual screenings since my late 30s, I intend to continue.
But with several cancer societies contradicting each other, they aren't making it any easier for women to get clear guidance. We're always being told to be our own well-informed advocates regarding patient care, but all I can say is, that's way easier said than done at times.
20
The issue is whether you are average risk or not per the article.
2
I didn't read that. I've read it twice now and unless I am completely misunderstanding, I am pretty sure it says get mammograms YEARLY from 45-54 and then every other year after 54. Which is only slightly more clear.
1
this is what I was referencing from the article
"The guidelines apply only to women at average risk for breast cancer — those with no personal history of the disease or known risk factors based on genetic mutations, family history or other medical problems."
"The guidelines apply only to women at average risk for breast cancer — those with no personal history of the disease or known risk factors based on genetic mutations, family history or other medical problems."
1
My wife of Asian origin and 60+ yrs, has no history of breast cancer in her immediate or extended family. She has not adopted the Western lifestyle and keeps healthy on whole foods. However, every year since she turned 50, her Doctor and the clinic, the insurance company keep pressuring her to have a mammogram. Now she gets angry every time someone tells her to have a mammogram.
Please tell American Cancer Society that some women don't need any mammogram at any age!
Please tell American Cancer Society that some women don't need any mammogram at any age!
14
Age is the biggest risk factor re: breast cancer. The older you are, your risk increases. If she does not want to have the test then she should just decline. It is up to her.
1
I was diagnosed with breast cancer at the age of 39 after a routine mammogram. I had no history of breast cancer in my family and was otherwise a very healthy person. I had "lumpy breasts" because of a fibrocystic condition, so my OB/GYN wanted a mammogram to "tell the old bumps from the new bumps." Thank goodness she ordered it and thank goodness the radiologist asked to take a second look, despite my young age. If I had followed the new guidelines--or even the old ones that had me waiting one more year until I was 40--no telling where I'd be. Today, I'm a 19 year cancer survivor. I think we should make our own decision of whether we want a mammogram or not. Because you just never know.
5
“But the task force gave the evidence for screening women under 50 a rating of “C,” reflecting its belief that the benefit is small. Services with a C rating do not have to be covered by the Affordable Care Act, according to the Department of Health and Human Services — a serious worry for advocates.” And there, I fear, lies the rub – the bottom line of saving money instead of potential lives.
My God, I was 24 year when a lump was discovered in one of my breasts from a routine mammogram. The medical steps taken thereafter to treat and eradicate this issue were swift, effective and lifesaving. I will always credit the early mammogram technology and my medical team for saving my life. Although my situation would be considered “an exception” and a “C” rating because of my age coupled with no family history, I am alive and doing brilliantly because of early detection and aggressive and smart thinking approaches by my doctors.
I understand the thought process behind the ACS recommendations regarding mammograms, but this paradigm shift will bring little comfort to those who develop breast cancer yet go undetected until their situation becomes life threatening because they fell off the screening grid due to their age and/or no family history.
4
The recommendations for people under 40 are especially hard (but you were having "routine" mammograms by 24?! really?? was yours really done because you felt a lump?) because cancers are rare then, but if you get one, it's much more likely to be aggressive than in older women. But that means the likelihood of an annual mammogram catching it -- at exactly the right time between it becoming detectable and yet not lethal -- is low.
7
Do you have a family history of breast cancer, or some other known factor? I ask because routine annual mammography at the age of 24 has never been recommended.
7
My mother died from lung cancer and three of her four siblings died from throat, liver and brain cancer.
My grandmother and my mother had mammograms as directed by their doctors - which meant every year. There was no family history of breast cancer, though we do tend to get skin cancers quite often. When it came to my turn, I made the personal decision NOT to have mammograms. I am now 71 and have never had a mammogram. Considering that I had no insurance until I was became eligible for Medicare, I figure I am both financially and healthwise 'way ahead of the game.
14
I am a physician and radiologist whose practice has involved mammography for at least 25 years. I know something about the modality. I must say that “Susan of Somers, NY” has it exactly right. By contrast, “Armistad of New York” and “Irene of Denver” offer anecdotal evidence that has no place in science. The available evidence does not support widespread screening. The ACS recommendations are prudent, evidence based, and likely will undergo further refinement years to come.
The national health care dollar is not an infinite sink. To pay for every unproven modality would break the bank, and then all of us would be losers.
The national health care dollar is not an infinite sink. To pay for every unproven modality would break the bank, and then all of us would be losers.
56
I started getting mammograms at 40. I am now 60 years old. There is no breast cancer on either side of my family. I've always had a "clean" diagnosis This is the first year I was thinking of skipping the test altogether. And now this article. So now what???
3
Discuss it with your doctor. You could try skipping a year, and see how that sits with you.
Uncertainty is nettlesome, isn't it?
Uncertainty is nettlesome, isn't it?
I really would like to see the end of "breast cancer hysteria". While there are some women who need screenings earlier and for a longer time, specifically women with known risk factors, most women do not. Sadly, for those who have very aggressive cancers, finding it early does not necessarily guarantee a happy ending. Until doctors and clinicians are able to distinguish aggressive cancers from the non-aggressive variety, screening earlier and more frequently leads to more women being treated overly aggressively and many others scared to death.
10
What we really need is better treatment for aggressive cancers. Mammograms are just a feel-good distraction. (They don't decrease the mortality rate from breast cancer. Just think about that, all you pro-mammogram people.)
8
You are absolutely correct. What most do not understand is that the breast cancer mortality rate has not significantly changed, yet the diagnosis of breast cancer has increased sharply. This may be due to overly aggressive treatment for cancers that would not be life threatening. I speak as a cancer survivor myself (no, not breast cancer) with a husband who died of cancer at a young age. We tend to fear the wrong things, as I learned from personal experience.
2
It has been known for years that routine mammogram screenings for no reason other than age (i.e., no family history, no lump found, no symptoms) have not decreased mortality and have caused unnecessary treatment (e.g., cutting and/or poisoning women over something that never would have caused a problem if left alone). The DCIS controversy, which this article finally touches upon, has been known since the 90's. Then there was the July 2011 study by Autier published in the British Medical Journal; the Bleyer & Welch Nov 2012 article in the New England Journal Medicine.... The only question is what took so long for the recommendations to change. Whether it is the misleading term calling DCIS a carcinoma (instead of a pre cancer, which is more accurate) or the faults in mammograms as a screening method, the head-in-the sand attitude in the face of the hard statistical evidence published in the peer review literature does not reflect well on the credibility of the medical establishment.
14
My sister was diagnosed at 37 (stage 4) and passed away 9 months later. Had she had a mammogram a year or two before, she may have had a smaller tumor and a chance of survival. It is important to note that we have NO familial breast cancer and she tested negative to the BRCA genes. She was symptomatic, visiting her doctors multiple times before getting the mammogram which clearly showed her tumor.
A very close girlfriend passed away 3 years ago. She was 46 and had been diagnosed at 41. She was in aggressive treatment throughout her battle. Her tumor was found via screening mammogram. She was neg for BRCA and was not symptomatic.
My best friend was diagnosed at 45. No family history, negative for BRCA. The cancer was found via a mammogram.
And there are more.
Mammograms are much cheaper (than treating a woman) than waiting til a woman is symptomatic.
The office breast exams are easy, effective and an opportunity to educate patients about BC risk, self-exams and discussion of a good healthy lifestyle habits.
Pre-menopausal women BC rates have increased and continue to grow. These women typically have very aggressive tumor types.
Health insurance companies would love to take this test and exam process off the ACA list of services. Cost effective testing should satisfy this issue.
Health insurance companies are one of the largest PAC's in the U.S. They get what they want...... Speak up!
A very close girlfriend passed away 3 years ago. She was 46 and had been diagnosed at 41. She was in aggressive treatment throughout her battle. Her tumor was found via screening mammogram. She was neg for BRCA and was not symptomatic.
My best friend was diagnosed at 45. No family history, negative for BRCA. The cancer was found via a mammogram.
And there are more.
Mammograms are much cheaper (than treating a woman) than waiting til a woman is symptomatic.
The office breast exams are easy, effective and an opportunity to educate patients about BC risk, self-exams and discussion of a good healthy lifestyle habits.
Pre-menopausal women BC rates have increased and continue to grow. These women typically have very aggressive tumor types.
Health insurance companies would love to take this test and exam process off the ACA list of services. Cost effective testing should satisfy this issue.
Health insurance companies are one of the largest PAC's in the U.S. They get what they want...... Speak up!
50
"A very close girlfriend passed away 3 years ago. She was 46 and had been diagnosed at 41. She was in aggressive treatment throughout her battle. Her tumor was found via screening mammogram. She was neg for BRCA and was not symptomatic"
Sorry to hear that. But it sounds like the mammogram didn't help her any.
Sorry to hear that. But it sounds like the mammogram didn't help her any.
2
One of your points doesn't quite make sense - you state that "mammograms are cheaper than waiting until a woman is symptomatic", but then state that "health insurance companies would love to take this test and exam process off the ACA list of services" - surely if breast cancer screening saved money, insurance companies would want people screened?
Unfortunately mammograms are a pretty poor test. They miss lots of cancers, and pick up lots of harmless lumps. In particular, mammograms perform very poorly in young woman - meaning that a mammogram would likely have missed your sister's cancer.
Indeed, the evidence that screening for breast cancer saves lives is very weak. Most countries have less intensive breast cancer screening programs that the US, and have similar or better breast cancer mortality figures. Switzerland has recently stopped breast cancer screening, as their cancer experts did not find it to be useful (and Switzerland is richer, with a better health system than the US).
Ultimately, money that is spent on mammography is money that could be spent on advanced treatments for women with cancer. Mammography is a pretty bad test, we need better ones, and we need better understanding of breast cancer.
Unfortunately mammograms are a pretty poor test. They miss lots of cancers, and pick up lots of harmless lumps. In particular, mammograms perform very poorly in young woman - meaning that a mammogram would likely have missed your sister's cancer.
Indeed, the evidence that screening for breast cancer saves lives is very weak. Most countries have less intensive breast cancer screening programs that the US, and have similar or better breast cancer mortality figures. Switzerland has recently stopped breast cancer screening, as their cancer experts did not find it to be useful (and Switzerland is richer, with a better health system than the US).
Ultimately, money that is spent on mammography is money that could be spent on advanced treatments for women with cancer. Mammography is a pretty bad test, we need better ones, and we need better understanding of breast cancer.
5
My sister, one of twins, lived a healthy life, had mammograms, had breast cancer detected at 50 and died at 52 after all the agony that chemo, surgery, and radiation could put a person through. Her twin, who smoked and was overweight, had no mammograms, and is still living eleven years later. My point is not that being healthy or having mammograms is bad, not at all. It's that anecdotal evidence, like yours and mine, is just that. (The main difference between the two that I see as possibly salient is that the "good" twin had taken birth control pills and the "bad" twin had never done so.)
1
All those folks who would have been dead by the new guidelines, I have several questions:
1. Was a palpable lump present?
2. Was your cancer DCIS or not? If it was DCIS, then how do you know you would be dead? because it spreads in only 30% of the cases
3. The problem with breast cancer screening is the question of what to with the ever improving resolution of the scans? i.e. just because it (whatever it is) is detected very early does NOT mean that it would become invasive.
4. The answer is regular self exam and eventually detection by circulating tumor cells NOT locally irradiation of your breasts and to those who have compared a mammogram to 4 days of living in NYC, I would like to point out that in that example; the dose is distributed over your entire body while in mammography the dose is directly deposited into a much smaller area.
1. Was a palpable lump present?
2. Was your cancer DCIS or not? If it was DCIS, then how do you know you would be dead? because it spreads in only 30% of the cases
3. The problem with breast cancer screening is the question of what to with the ever improving resolution of the scans? i.e. just because it (whatever it is) is detected very early does NOT mean that it would become invasive.
4. The answer is regular self exam and eventually detection by circulating tumor cells NOT locally irradiation of your breasts and to those who have compared a mammogram to 4 days of living in NYC, I would like to point out that in that example; the dose is distributed over your entire body while in mammography the dose is directly deposited into a much smaller area.
8
1. No
2. No.
3. Well, it was invasive.
4. Regular self exam would not have detected my small yet invasive tumor. I'd have been in big trouble if the lump wasn't found early through mammogram.
2. No.
3. Well, it was invasive.
4. Regular self exam would not have detected my small yet invasive tumor. I'd have been in big trouble if the lump wasn't found early through mammogram.
I was diagnosed with an aggressive form of breast cancer at age 57, with no known risk factors other than (a) being childless and (b) getting older. Under the Cancer Society's new guidelines, I would have had a mammogram at 56, when no cancer was present, and again at 58, by which time the aggressive cancer would have metastasized. The Annual Routine Screening Mammogram saved my life. I realize I am just one data point, but still...I like being alive and healthy!
10
I do not mean to be insensitive, but how do you know that a mammogram saved your life. As a survivor myself, I am aware we may not know for more than 15 years if that is the case. Stage 4 can occur 15 or more years later.
3
SAved my life: as in, I am alive and well today. As for tomorrow (or next year, or next decade), who can say? I am content with today, and I hope for tomorrows. Without that mammogram, I would have missed out on eight years (so far) of "todays".
Per a commenter below: *8 friends of mine developed breast cancer before the age of 40 and died from it, and I've had many, many more friends who were diagnosed between the ages of 30-50 but luckily survived.*
I*d like to know why so many younger women are developing this disease. That's a question dwarfing the controversy over when to begin mammographic screening of breasts.
How many times do we need to shout *mammography is NOT prevention?*
Certainly we know that cancer is not particularly a disease of older people--the unbearable tragedy of pediatric cancer proves that. Are early cancers in women actually a sort of invisible continuum of the development of pediatric cancers? Is there a genetic link between a child with some forms of cancer and a 32-year-old with breast cancer?
And I must say I*m a little stunned by comments from women in their late seventies/early eighties still going obediently for their mammograms with no previous history of cancer. If your doctor finds something, what do you intend to do? If you feel healthy now, live a reasonably active life, are independent--do you want to endure treatments that will destroy what you have for some perhaps illusory *cure?* Do you think weakening your bones and your immune system is going to improve your life?
But more importantly--are we all children? Do we not have a little understanding of our own bodies by now? Can we not all learn to perform clinical breast exams ourselves? Make our own choices?
I*d like to know why so many younger women are developing this disease. That's a question dwarfing the controversy over when to begin mammographic screening of breasts.
How many times do we need to shout *mammography is NOT prevention?*
Certainly we know that cancer is not particularly a disease of older people--the unbearable tragedy of pediatric cancer proves that. Are early cancers in women actually a sort of invisible continuum of the development of pediatric cancers? Is there a genetic link between a child with some forms of cancer and a 32-year-old with breast cancer?
And I must say I*m a little stunned by comments from women in their late seventies/early eighties still going obediently for their mammograms with no previous history of cancer. If your doctor finds something, what do you intend to do? If you feel healthy now, live a reasonably active life, are independent--do you want to endure treatments that will destroy what you have for some perhaps illusory *cure?* Do you think weakening your bones and your immune system is going to improve your life?
But more importantly--are we all children? Do we not have a little understanding of our own bodies by now? Can we not all learn to perform clinical breast exams ourselves? Make our own choices?
11
Rather than wondering why young women are getting breast cancer, I would doubt the anecdotes of the original poster.
3
I think the anecdotes about younger women dying from breast cancer stand out, because they are especially sad. I'm not sure if there are more breast cancer deaths among young women nowadays, or if we're more likely to hear about them now (because of the Internet).
Please tell me what top say to the woman, who I diagnosed a breast cancer last week, who was thirty years old. OR the woman yesterday, who had a normal mammogram 2 years ago at 38 years old and has a definitely new cancer, yesterday, at age 40. Should we just ignore them. I have seen 5-7 cases of breast cancer in 30-40 year olds in the past 4 months and 25 cancers in 40 year olds. I very often see cancers in those women who decide to skip a year.
The cost of treating the more advanced cancers is astronomical compared to screens.
Yet for all those who go for colonscopies, it is ok for the docs to remove 2-4 mm benign appearing hyperplastic polyps that will become nothing - they are reimbursed and no fuss is made. Why, I wonder.
Why do academics, who analyze data and not see patients, come out with these outlandish recommendations that make page 1 and scare women away from a potentially life saving screen.
When a better test is devised, then recommendations might be modified. Do mammograms do more harm than good, I think not.
OR should we bring up radiation exposure - a new digital mammogram with additional "3D" imaging gives a woman the same radiation as breathing NYC air for 4 days or flying 1200 miles in a plane. Maybe we should ban NYC or flying.
The cost of treating the more advanced cancers is astronomical compared to screens.
Yet for all those who go for colonscopies, it is ok for the docs to remove 2-4 mm benign appearing hyperplastic polyps that will become nothing - they are reimbursed and no fuss is made. Why, I wonder.
Why do academics, who analyze data and not see patients, come out with these outlandish recommendations that make page 1 and scare women away from a potentially life saving screen.
When a better test is devised, then recommendations might be modified. Do mammograms do more harm than good, I think not.
OR should we bring up radiation exposure - a new digital mammogram with additional "3D" imaging gives a woman the same radiation as breathing NYC air for 4 days or flying 1200 miles in a plane. Maybe we should ban NYC or flying.
84
The question is whether those cancers would have killed the women in question. Studies that look at mortality find that mammograms don't decrease mortality. In other words, a woman is no less likely to die of breast cancer if she has mammograms than if she chooses to forgo mammograms. Why have repeated testing, biopsies, surgery, and chemotherapy for something that would not have killed you in the first place? This is why we need to make decisions based on statistical analyses, not anecdotal evidence from physicians. I applaud the American Cancer Society's decision.
25
You ask if mammograms do more harm than good, and that's exactly what's at the heart of these changes. The science behind them shows that, as I recall, some 99% of the women enduring biopsies, surgeries, chemo, radiation, fear and despair, are doing so for "cancers" that were either false positives or not actually dangerous at all. This may include some of your own patients.
Breast cancer has been terribly over-treated, and the vast majority of "survivors" could have been spared the whole ordeal.
Breast cancer has been terribly over-treated, and the vast majority of "survivors" could have been spared the whole ordeal.
24
sounds like Dr. Welch despite the NJ address
2
The affordable care act was supposed to get rid of "unnecessary" medical tests and treatments, but this recommendation shows how difficult it is to implement. The ACS is facing the reality that "cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. We’re treating hundreds of thousands more people each year for these diseases than we ever have. Yet only a tiny reduction in death, if any, has resulted."
http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
Will President Obama have the courage to allow his own law to work? Will he allow Medicare and Medicaid to stop paying for mammograms performed outside of these guidelines?
http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
Will President Obama have the courage to allow his own law to work? Will he allow Medicare and Medicaid to stop paying for mammograms performed outside of these guidelines?
3
This is a recommendation. It is not a law. There is a difference, you know. Or will you risk someone to think that Repubs don't know the difference?
2
As a breast cancer "survivor," I find these new guidelines preposterous. I agree with every one of you who has lamented that callbacks and false-positives are nerve-racking, costly, and time-consuming. But having spent time on the other side of that table (for reader reference I was 42 at time of dx, incredibly healthy and fit, no family history, etc.), I have met many women for whom a mammogram (and ultrasound) detected invasive breast cancer. Most of them fit into the same healthy, no obvious risk category as me. I'd have metastatic systemic cancer at this point or perhaps not be here at all. For someone who has spent time in a chemotherapy infusion chair this is an outright insult. I was lucky enough to have my aggressive BC detected before it spread to lymph nodes. Someone was smiling down on me....
And to do away with the clinicians' physical breast exam is ludacris. It takes a few minutes at best and can detect lumps that the patient has neglected to feel. I cannot believe what I'm reading. I'm inclined to believe there is something greater happening behind the scenes than is meeting our eyes.
And to do away with the clinicians' physical breast exam is ludacris. It takes a few minutes at best and can detect lumps that the patient has neglected to feel. I cannot believe what I'm reading. I'm inclined to believe there is something greater happening behind the scenes than is meeting our eyes.
31
Yes, there is something greater happening behind the scenes. It's called statistical analysis. I would much rather have our health guidelines be based on statistical analysis than on anecdotal data from people who resort to conspiracy theories because they don't understand mathematics.
Research shows that mammograms don't decrease mortality rates. If you want to understand, here is a pretty good explanation:
https://www.youtube.com/watch?v=gNiORew3uRY
Research shows that mammograms don't decrease mortality rates. If you want to understand, here is a pretty good explanation:
https://www.youtube.com/watch?v=gNiORew3uRY
8
Insurance companies save a bundle under this new guideline. I suggest that's what going on.
1
I disagree. Look at the science. I too am a breast cancer survivor and had annual mammograms for years and at age 52 I found the lump. Turned out to be a 3.5 cm 60% DCIS and 40% UDC. Ummm interesting that this did not show up on prior years. But I am just one story which really does not help to draw any conclusions for the general population from a scientific perspective.
This issue is very emotional for women and we have trouble letting go of our stories when it relates to the science..
This issue is very emotional for women and we have trouble letting go of our stories when it relates to the science..
8
It's helpful to issue optimum guidelines, of course. But only half of women follow them. Many insured and many more uninsured don't bother with mammograms. For this reason, I think the Cancer Society should adopt a minimum standard as well as the optimum. As one who is lax about my own health screening, I believe I would respond to a minimum standard of care. I'm not inclined to be vigilant, but I won't let myself drop below the minimum.
3
I am so glad that ACS made this decision to delay screening mammograms for women who have low risk or have no history of breast cancer in their families. This has been a long debate within the breast cancer community. Many breast specialists never really bought into screening over 40 every single year for all women. But with fear of medical malpractice, lack of better technology (mammography is not perfect but it's the best we have) and lack of good data on risks and benefits of screening mammograms done to all women (regardless of risk and history).
Additionally, the breast cancer awareness movement, unfortunately, also provided misinformation to many women. Now that we know that there are subtypes of breast cancer, molecular testing and appropriate staging of disease, we know that Ductal Carcinoma In Situ (DCIS) is not cancer.
We all need to welcome this new recommendation because it's science-based with substantive data to back it up. Doctors need to better explain this to their patients in a health-friendly manner. And encourage women to know their bodies, medical history and understand the research behind the new recommendation. It's all good and I hope that this news will encourage everyone to better understand how we need continued medical research!
Additionally, the breast cancer awareness movement, unfortunately, also provided misinformation to many women. Now that we know that there are subtypes of breast cancer, molecular testing and appropriate staging of disease, we know that Ductal Carcinoma In Situ (DCIS) is not cancer.
We all need to welcome this new recommendation because it's science-based with substantive data to back it up. Doctors need to better explain this to their patients in a health-friendly manner. And encourage women to know their bodies, medical history and understand the research behind the new recommendation. It's all good and I hope that this news will encourage everyone to better understand how we need continued medical research!
76
Only a person who has not been touched by this disease can make such comments. I have lost several young friends, under 40, to breast cancer and my mother who died at 44 after fighting the disease for 7 years. That was 50 years ago when early detection and better treatment may have helped her survive longer. But over the past 25 years I have also seen 3 friends survive, all now past 20 years, due to early detection and treatment. They are wives, mothers and friends.
Applying logical thought and science is great until you have to tell a young woman and mother that she is terminal but early detection and treatment could most likely have saved her life.
Applying logical thought and science is great until you have to tell a young woman and mother that she is terminal but early detection and treatment could most likely have saved her life.
3
I have been touched by the disease and I have to disagree with your comment.
2
And just why, Joe, would you tell a terminal woman that? Do you think she needs to feel worse than she does? Or perhaps a bit of guilt might be therapeutic? When in fact you don't know in the least that early detection would have saved her life. My sister had that and died a gruesome death after two years of hell. In her case, not knowing longer would've been a blessing, frankly. So save the "maybe, gee" business, or just mutter it to yourself, if you must, on the way home from work.
3
As with 'climate change', this is all about politics. How come? It is an attempt to bend the cost curve down, nothing else. Shame on the Society to be party to this. What is the bottom line? If the Society's guidelines are followed it will eliminate about $18 billion of costs each year, offset in part by about $3 billion for increase costs for actual treatment of more serious cancer treatments when the 'missed' cancers are not discovered until later. Net profit to the insurance companies, $15 billion. You can be sure these findings will be used by your insurer to refuse you a regular test starting at age 40. They profit, you die. Its that simple. Don't be fooled.
4
On the contrary, it is the breast cancer industry that is in favor of multiple mammograms. Think of the manufacturers of mammography machines, ultrasounds, radiologists, and especially the highly paid executives of the pink charities whose mission is breast cancer "awareness", and you will see where the push for excessive diagnostic testing comes from. Just follow the money
4
I am a Senior and have a mammography every year. Two years ago I was called back to have a sonogram which seems to be the trend and it scared me having to wait 5 days til I had it. Nothing found. Last year the Radiologist came into the room just before I had the somogram and told me that in my case it was a waste of time and money and to have a mammo only.
1
Don't waste money on cancer research. That only benefits the health care industry, doctors, health care providers and drug makers. Spend all these monies to provide health care for the poors and educate the public how to eat healthy. Our life expectancy will go up.
3
Good news I guess. As a woman it is confusing to figure out what is what. We should get a yearly mammogram if we're over 50. No, we shouldn't get a yearly mammogram. We try to do what's best for our bodies with limited and conflicting information. What if in 3 years they change the protocols again?
We muddle through, and keep in mind that medicine is an art as well as a science. The uncertainty is difficult to cope with, but it's a part of life. Take it a day at a time.
I'm 41, and got diagnosed with epilepsy in 2006. It changed my perspective about a lot of things.
I'm 41, and got diagnosed with epilepsy in 2006. It changed my perspective about a lot of things.
The "Shift" is likely due to Gerd Gigerenzer's book "Calculated Risks" where he clearly shows how to deduce the actual risks to benefits of screening and in particular Breast Cancer Screening in his Chapter 5. The book is very understandable by a layperson and I highly recommend reading it.
6
This really scares me. As a women who was diagnosed under 40, I know It is essential that younger women have the option to have breast exams early and be covered. MRI's should also be available to younger women since mammograms are not as accurate with younger women or women with dense breasts. Every one knows early detections saves lives, and yes there may be some false positives, medicine is never always accurate.
6
That coverage won't be going away as a result of these recommendations. They're guidelines, not a mandate.
Just another way to make insurance companies happy. If you find breast cancer early it would be less cost. they found the cancer in my daughter at age 41. test were done every one to two years because her breast are so dense and all of a sudden there it is. I know there are many false positives but stopping early testing is wrong. younger women are being diagnose every day. I will continue to be screened and if insurance companies wont pay, so be it. I am concerned that the facilities will not do screening just because of your recommendations. Please let us be in control of our health.
4
Given the pivotal role mammograms have played in decreasing death from breast cancer, I am very saddened to see this change.
4
Mammograms have not decreased deaths from breast cancer. They have increased "survival rates." Before you get too excited about that, make sure you understand what "survival rate" means:
https://www.youtube.com/watch?v=gNiORew3uRY
https://www.youtube.com/watch?v=gNiORew3uRY
4
The evidence that mammograms play such a pivotal role does not exist because they do not play such a role.
2
But mammograms HAVEN'T decreased deaths from breast cancer. Our death rate from breast cancer is nearly identical to that of say, Great Britain, where mammograms are done far less often. We have only increased our survival rates. That sounds good - giving folks more time is good, right? - but increased survival rates can look like this: we found a cancer via mammogram at 35 and with treatment she survived until 45; without the mammogram, we would have found her cancer at 40 and she still would have died at 45.
8
This is a very BAD idea.
I am a poster child for mammograms. My cancer discovered early and removed. I could never have found it with a self exam and, by the time I (or my doctor) did, it would have advanced to the lymph nodes and treatment would be far more invasive and far more radical.
Again...a BAD idea.
I am a poster child for mammograms. My cancer discovered early and removed. I could never have found it with a self exam and, by the time I (or my doctor) did, it would have advanced to the lymph nodes and treatment would be far more invasive and far more radical.
Again...a BAD idea.
6
How do you know that your cancer would have killed you? Therein lies the question. The most rigorous studies show that mammograms don't affect the mortality rate. Try first to understand the science before concluding that this is a "BAD idea."
3
It's a post hoc logical fallacy that makes you sure you would have died without the mammogram. First you had the mammogram, then you had treatment, then you survived; so it seems due to the mammogram. Actually, you may well have survived having found the cancer later; there's no one way that cancers do progress, and a number of different kinds of cancer involved. But it's understandable that it appears as it does to you.
1
Bravo to the mammogram recommendations; breast cancer screening has become just another self-perpetuating medical industry. As a woman with frequent call-backs and negative biopsy, I finally said no to the sacred yearly mammo. However I do see value in clinical breast exam and periodic breast self-exam - I believe in knowing your body and paying attention to subtle changes.
135
You are deceiving yourself. If you ever do develop anything abnormal, and I certainly hope you don't , you're only cheating yourself
Armistad, your comment is unnecessarily harsh.
1
The clinical breast exam is wonderful when a doctor who sees you once or twice a year, remembers what you exactly feel like. All those cases that are clinically felt, are large by mammographic standards. You should know your body, but every month pre-menopausal, your breasts dramatically change, very hard to know what is and isn't real.
So no PAP tests, no Mammograms, no Clinical Breat exams? What? No more doctor visits, ladies- just wait around for cancer, that is if childbirth didn't kill you. Oh yeah, and get back in the kitchen.
14
This is not what is being said at all.
10
So, maybe only see the physician when you're really sick?
Broad brush, don't you think?
Doctors have been "following" a spot in one breast for years. I had already decided that more radiation just might cause a cancer and planned to skip the exam this year, especially since I'm 84 years old. Since I'm probably not expected to live 10 more years, I'm definitely free from more. Hallelujah!!
37
Congratulations.
I refuse to x-ray my breasts. Period. Not at 40, 45, or 50! It makes no sense to me that tissue so sensitive to radiation would be x-rayed every year. Also, we do not screen our other organs that way, annually. Furthermore, heart disease is the number one killer of women; lets focus more on screening in that area.
61
I respect your opinion and it your choice. My sister didn't have a mammogram until she was 50 and she had a large malignant tumor. She passed away last spring from metastitic breast cancer. It sucks. I can't think; "what if", because that doesn't help our loss, but I would encourage women to do their mammograms when recommended by scientists who are knowledgeable. It's not a big deal, it takes 5 minutes the test does save lives. Early detection of breast cancer can be integral to successful treatment and hopefully a cure.
Do careful self-exams regularly, then, Katherine. And may you never need anything more invasive.
I plan to wait till I'm 50, a decision my doctor supports.
I plan to wait till I'm 50, a decision my doctor supports.
I am happy for those women who say that their life was made better by mammography. However, when making recommendations about public health, the whole of the population must be considered. Many women are harmed by mammography.
If I had relied on mammography, my cancer may have never shown up. I had a palpable lump that could not be seen on a mammogram-- even knowing where it was. I went through chemo hearing to more and more stories like mine of a palpable lump that could not be detected by mammography. I spoke with women who felt something, but said nothing to their physician because they had just had clean mammograms. There is no way to do a study to track these women. They are harmed by false security.
My sister went through two biopsies for false alarms. My mother went through at least one. At 78 her doctor scheduled her for a mammogram, and she had a callback. When I found out that one had been scheduled at all, I wanted to scream. Another friend has gone through more than I can count. None of them have suffered from any disease.
Unfortunately, I think that the guidelines from the ACS will cause more confusion than clarity and will cause more headaches with insurance companies. If physicians do not have time to do a breast exam, they certainly do not have time to explain the relative risks and benefits of mammography in any sort of a reasonable way.
If I had relied on mammography, my cancer may have never shown up. I had a palpable lump that could not be seen on a mammogram-- even knowing where it was. I went through chemo hearing to more and more stories like mine of a palpable lump that could not be detected by mammography. I spoke with women who felt something, but said nothing to their physician because they had just had clean mammograms. There is no way to do a study to track these women. They are harmed by false security.
My sister went through two biopsies for false alarms. My mother went through at least one. At 78 her doctor scheduled her for a mammogram, and she had a callback. When I found out that one had been scheduled at all, I wanted to scream. Another friend has gone through more than I can count. None of them have suffered from any disease.
Unfortunately, I think that the guidelines from the ACS will cause more confusion than clarity and will cause more headaches with insurance companies. If physicians do not have time to do a breast exam, they certainly do not have time to explain the relative risks and benefits of mammography in any sort of a reasonable way.
20
Your comment brings up an important point. What's with these "callbacks?" A woman should stay in the office until the radiologist reads the xray and talks with the patient. There is no excuse for a woman to have the xray, go home and wait for someone to tell her the results. At the practice in NYC where I used to go for the annual mammo, the radiologist did a quick clinical palpation, then the xray was done by a tech, I stayed in my robe until the radiologist called me to show me the xray results and explain everything, as needed. That is the way these should be done whether the mammo is annual, biannual or every five years.
1
If one is interested in the best science, this recommendation will make sense to you. If not, if you prefer to make emotional decisions, no amount of data will convince you. The emotional decision makers logically should be having head to toe scans everyone followed up by biopsies of any noticed anomalies. Seems to me that those who chose not to follow the guidelines should pay for the extra screenings and follow-up out of pocket.
23
Just another way for insurance companies to screw over women. It's absolutely disgusting to see the erosion of women's rights on our health concerns. 8 friends of mine developed breast cancer before the age of 40 and died from it, and I've had many, many more friends who were diagnosed between the ages of 30-50 but luckily survived. I've been fortunate and only had 2 biopsies which were both negative, but I wouldn't have wanted to walk around with a lump in my breast just wondering if it's a ticking time bomb. I would love to know how many men were involved in writing the American Cancer Society's newest horrible recommendations. I'm sure the percentage of men who wrote this is much higher than the percentage of women.
12
Sad to say, there is basically no evidence that breast cancers detected in women < 40 are more treatable if detected 'early' by mammogram (if a breast cancer is very aggressive, as is often the case in younger women, finding it by mammogram won't necessarily save her) nor that mammograms are the reason your friends survived. The ACS guidelines group was gender-balanced. The saddest part of the endless mammogram wars is that they distract from what would actually make a difference and should unite us all: finding effective primary prevention and treatment that would work no matter what stage cancer reached.
9
a better screening tool is needed for the group of women you are writing about. Mammograms are not as effective for that group.
2
With that many friends who had cancer before age 40, you might want to examine your environment for carcinogens--it's not normal.
2
What is sad is that many people don't understand that these new guidelines reflect the fact that we have made great strides on the diagnosis and treatment fronts for breast cancer. Genetic screening does a good job of identifying women at risk and, as sequencing technologies, get both cheaper and faster we will have better pictures of "risk profiles" and come up with less invasive and more accurate diagnoses than mammograms. All the while in the treatment arena steady progress has been and continues to be made and promise of the new immuno-oncology drugs is immense with technologies like cancer vaccines and engineered viruses that kill tumors now being tested clinically. So all of those tax and donated dollars for cancer research and treatment are paying off!
32
Genetic screening occurs AFTER a women has been diagnosed. Further, the current tests only identify two genes out of thousands. The test costs $3-4k. As for treatment, yes, much excitement in the pipeline for treatment advancement. As of today, standard treatment (surgery, chemo and radiation) is the gold standard. We do not have a magic virus bullet.
For further information on funding cancer research and the participants (to include pharma companies) please go to: iom.nationalacademies.org
For further information on funding cancer research and the participants (to include pharma companies) please go to: iom.nationalacademies.org
1
Agreed! However, please also include addressing the health disparities that exists in this country. African American women are more likely to die, get late stage diagnoses, lower quality health care or lack of access to new screening technologies or newer treatments and cancer drugs. Eliminating breast cancer disparities is also extremely important. We need to improve the lives of ALL men and women.
1
Genetic screening does a LOUSY job of identifying women at risk. Ninety percent (90%) of breast cancer patients have No Known Risk Factor other than possessing breast tissue.
1
Yes, I would be dead if my insurance company took the ACA advice to heart and refused to cover a mammogram. What is missing here is crucial information: if not a mammogram, then how is breast cancer to be detected? What test takes its place? How are we now supposed to find out we have a cancer that usually shows no outside symptoms? It seems the obvious answer is that we will find out LATE, very late, when a tumor has grown visible or we are sickened by cancer that has spread to the lymph nodes and invaded the body.
It seems to me that is a prescription for 1) more deaths from advanced undetected cancer and 2) more drastic treatment to arrest cancer that has invaded bones, brain, lungs.
That sounds a lot more miserable than a little anxiety over a false positive reading, or a biopsy that turns up good news.
I hardly think this is a step forward for women...
It seems to me that is a prescription for 1) more deaths from advanced undetected cancer and 2) more drastic treatment to arrest cancer that has invaded bones, brain, lungs.
That sounds a lot more miserable than a little anxiety over a false positive reading, or a biopsy that turns up good news.
I hardly think this is a step forward for women...
28
I think you meant the ACS Recommendation.
The ACA requires insurance to cover an annual mammogram for every woman over the age of 40. Your insurance company has no option to take the recommendations of the ACS "to heart", they must follow the law.
The ACA requires insurance to cover an annual mammogram for every woman over the age of 40. Your insurance company has no option to take the recommendations of the ACS "to heart", they must follow the law.
8
Probably you meant National Task force recommendations - ACS recommendations just came out. The National Task force has no Radiologists, radiation Oncologists, Breast Surgeons or Breast Oncologists but they manage to make recommendations.
1
Apparently it's not enough for the ACS to kill me off once. Based upon these guidelines, I'd be dead TWICE. And that's with NO family history of breast cancer and a clean baseline mammogram at 35 at which I was told I had nothing to worry about. First cancer was at 42, second was at 46. First time the pictures found the cancer, second time the doc found the lump and then the pictures confirmed. Sorry ACS, but I have family and friends to care for, an employer at which I do constructive work, a church I support, and volunteer opportunities from which I believe they benefit from my time. I can see that that sort of life is of ZERO value to them to the point where they can write me off as a rounding error.
18
dj - you presume you would have died if those cancers of yours had not been found and removed. That may not be the case. Many cancers don't kill. Please get the facts before making such presumptions and assuming that the new medical guidelines are wrong.
33
But it might have been the case. I was diagnosed at 47. I, for one, am glad that it was found sooner rather than later. I don't know if it would have killed me if I'd waited but that's certainly not a chance I would have wanted to take.
3
Wishful thinking here. Breast cancer is a fatal disease, and one for which there is no known cure. One's best bet is to avoid it, not to count on being "cured" if and when you get it!
1
It is encouraging to see the medical community adopt more nuanced approaches to diagnosing and treating diseases like breast cancer because the diagnostic and therapeutic procedures are far from definitive, can lead to unnecessary interventions and cause life-degrading side effects. Unfortunately, in this gray area of what tests or procedures to have done, consumers will continue to find old and new ways of thinking among physicians which only makes finding a clear path forward more difficult. I think patient education is the key and the links in this article provide valuable information toward that end.
1
I am surprised by this news and disappointed. I find it unsettling to learn the ACS would make this recommendation based on findings of imperfect mammograms which require additional testing or biopsies.
They do not mention any risk to women if they have annual mammograms. It seems to me that the consideration of no or low risk vs. the chance of discovering a terrible disease early would have them advising continuing the practice of annual mammograms to support early detection.
What does Susan Komen have to say? I am personally very glad I had an annual mammogram.
They do not mention any risk to women if they have annual mammograms. It seems to me that the consideration of no or low risk vs. the chance of discovering a terrible disease early would have them advising continuing the practice of annual mammograms to support early detection.
What does Susan Komen have to say? I am personally very glad I had an annual mammogram.
3
It is all about the money insurance companies won't have to pay out, never mind that more women will die. And please tell me what the big deal regarding biopsies is, a biopsy of a little nothing probably saved my life. It definitely saved me from absolutely horrible experience. Mark these recommendations as the years go by as every type of screening will be advised against. Hopefully you have an on the ball doctor who treats each individual according to her situation.
Medicine practiced via odds makers is not medicine it is Las Vegas where the house always comes out ahead.
Medicine practiced via odds makers is not medicine it is Las Vegas where the house always comes out ahead.
6
This is outrageous. Just join a facebook breast cancer group or cancer forum and you'll see... MANY young women with no symptoms whatsoever, nor family history, are diagnosed way before age 40. And by the time they're diagnosed it's already too late as it has spread to lymph nodes or metastasized. As long as science can't come up with a proper blood test to detect cancer, ACS should recommend screening to as many women as possible. One life lost to lack of screening is one too many.
5
"one life lost... is too many"? Sorry, but an ideal world does not exist. Mammograms are not perfect, there are false negatives. And even cancers caught and treated early, if aggressive enough, can be fatal despite the doctors and patient having done everything possible.
11
If those women were diagnosed way before 40 they would not have been helped by the previous protocol of screening after 40 anyway.
3
have one if " ... expected to live another 10 years."
age 74 and how the heck am I to know if I'm expected to live another ten years?
age 74 and how the heck am I to know if I'm expected to live another ten years?
5
If you were incapacitated by heart failure, a stroke, crippled by severe diabetic disease, dementia or other problem, there would be the presumption that you won't live into your 80s. At 74, you are expected to live into your 80s based on average life expectancies as long as you are in reasonable health.
2
I commented on this below, but people have to understand that these types of studies are at the core of taking care of a population with limited resources. "Death panels" may be ill named, but it is exactly panels like this that determine what tests are necessary and how often, and what would be paid for by medicare or any single payer. Some individuals will suffer with these recommendations, but the population as a whole will benefit. The American population must understand this when demanding single payer health care.
7
there is also a risk from the radiation from an xray, the more dense your breast is the more radiation is needed to penetrate the tissue, this is hard to quantify or test the impact of but it is a fact
8
The comments below largely reflect a misunderstanding of the very complicated topic of cancer screening. Recommendations are affected by better understanding of cancer biology, and address real concerns about over-diagnosis. The lay public generally can't accept the idea that a cancer may behave in a certain manner, and respond or not respond to treatment, regardless of when or how it is detected, and that these interventions may not have any real effect on disease outcome for some patients. That's just reality.
I suspect that the butt- covering comments by ACS to "allow" variations is less an indicator of lack of confidence or appeasement of radicalized patients (ibid) but more an attempt to prevent amoral insurance companies from excluding these non-standard exams from insurance coverage. I'm sure they are salivating over the extra premiums they can hoard by using slimmed down screening recommendations as a denial weapon. That's the new New Health Care.
I suspect that the butt- covering comments by ACS to "allow" variations is less an indicator of lack of confidence or appeasement of radicalized patients (ibid) but more an attempt to prevent amoral insurance companies from excluding these non-standard exams from insurance coverage. I'm sure they are salivating over the extra premiums they can hoard by using slimmed down screening recommendations as a denial weapon. That's the new New Health Care.
2
The ACS does not drive insurance company policy.
I have an improvement to the new guidelines- if you want to only do a test every other year, do an MRI that doesn't emit radiation. The MRI cost would be mitigated by doing it every 2 years instead of yearly if you are at no high risk for breast cancer- otherwise, yearly MRI.
The MRI is much more effective in diagnosing breast cancer than a mammogram- so we should switch to MRIs and not do mammograms which emit radiation. MRIs are a safer alternative and of course, much more effective tool. The only reason we don't do it now is cost as dictated by the insurance industry.
Finally, the idea that your doctor should not do an office breast exam is nonsense. It costs nothing and is done while in the doctor's office and requires no equipment, etc. Why in the world would the recommendation be against this practice? This makes no sense and I will continue to have my doctor perform this screening.
The MRI is much more effective in diagnosing breast cancer than a mammogram- so we should switch to MRIs and not do mammograms which emit radiation. MRIs are a safer alternative and of course, much more effective tool. The only reason we don't do it now is cost as dictated by the insurance industry.
Finally, the idea that your doctor should not do an office breast exam is nonsense. It costs nothing and is done while in the doctor's office and requires no equipment, etc. Why in the world would the recommendation be against this practice? This makes no sense and I will continue to have my doctor perform this screening.
19
MRIs do require radiation (in the dye that is injected intravenously), and at a far higher dosage than mammograms. In addition, the cost is obscene and the procedure extremely uncomfortable as it requires the patient to not move for 40 minutes while fire alarm noises is blasted through their ears.
Ultrasounds are cheap, accurate, painless, comfortable and fast at detecting lumps.
Ultrasounds are cheap, accurate, painless, comfortable and fast at detecting lumps.
3
Marian,
MRIs cost ten times as much as mammograms, still with no clear lowering of the death rate from breast cancer. Here's an ethical idea: how about we stop wasting money on gilding the health care lily in this country and use that money instead to treat malaria, TB, HIV, river blindness, dracunculiasis, and other debilitating diseases among the less fortunate in developing countries. Let's devote money to what CLEARLY works!
MRIs cost ten times as much as mammograms, still with no clear lowering of the death rate from breast cancer. Here's an ethical idea: how about we stop wasting money on gilding the health care lily in this country and use that money instead to treat malaria, TB, HIV, river blindness, dracunculiasis, and other debilitating diseases among the less fortunate in developing countries. Let's devote money to what CLEARLY works!
4
The recommendations about mammograms are correct because they fail to detect cancers in those aged 60 and younger. A mammogram is essentially an xray, and all younger women have dense breast tissue - this makes mammograms useless as a diagnostic tool.
A more appropriate and life-saving screening tool - for women of ALL ages, especially - is an ultrasound. Alike a mammogram machine, an ultrasound is cheaper and less painful way to diagnose aggressive breast cancers (like triple negative breast cancer) in women who can least afford to have them, like the poor and minorities. It is extremely disappointing that the American Cancer Society adamantly refuses to vocalize its support for ultrasound machines.
And by the way, I was diagnosed with triple negative breast cancer, stage 3, this past August, at the age of 32.
A more appropriate and life-saving screening tool - for women of ALL ages, especially - is an ultrasound. Alike a mammogram machine, an ultrasound is cheaper and less painful way to diagnose aggressive breast cancers (like triple negative breast cancer) in women who can least afford to have them, like the poor and minorities. It is extremely disappointing that the American Cancer Society adamantly refuses to vocalize its support for ultrasound machines.
And by the way, I was diagnosed with triple negative breast cancer, stage 3, this past August, at the age of 32.
19
My mammography picked up my tumor when it was unseen on the ultrasound. Six months later, it was also visible on the ultrasound. These broad generalizations are not helpful.
4
My cancer was diagnosed at age 49 - by mammogram, followed by an US and MRI which showed the extent of the tumor. I am also a radiologist. US is more or less useless for subtle, invasive cancers and for calcifications which are sometimes the only indication of a tumor. Whole breast and targeted us have both been studied and it is an inferior test for detection compared to mammography, MRI and molecular breast imaging. Triple negative breast CA is awful and I am sorry you have had it - but US on its own is not enough. At your young age at diagnosis it would have been the first test possibly - but not the last or definitive one.
2
As a retired surgeon, and knowing that aggressive breast cancers may develop in between mammograms, agree with allowing more space in between studies (digital mammograms, MRI's, etc). However, I differ when clinical exams are disregarded as mere 'window dressing'; aside from feeling a dominant mass (fibroadenoma the most common cause in premenopausal women, not cancer, but exceptions to that 'rule' are more than anecdotic), one may find an inverted nipple (and if recent, an indication to rule out an underlying malignancy), or skin retraction or asymmetrical findings that may lead to an occult tumor. And, of course, as part of a breast exam, the axillas ans supraclavicular spaces must be checked as well. All this, at prudent intervals, usually yearly...unless an educated guess by the patient herself if acute changes are noted. Of note, if a man comes in for a check-up, both breasts must be checked as well, as 1% of breast cancers occur in men. It is hoped that, in the not too distant future, better and less invasive/intensive/uncomfortable methods for early diagnosis of breast cancer become available, including saliva, urine, blood parameters. The importance of early diagnosis cannot be emphasized enough, having observed, with sadness and frustration, premature death, and untold suffering once chemotherapy/radiotherapy/ infections and a myriad of disgusting side effects take hold of an otherwise 'healthy' woman. when metastases are found ( and denying effective control).
19
I know this is a touchy subject for women. My sister have stage 4 breast cancer because the techs told her for 18 months it was probably nothing and they'd just keep an eye on it. I had a bad mammogram, followed by a dozen new films to diagnose it. They revealed a lump about the size of bean. I waited an agonizing seven weeks before I was able to get a biopsy only to find it was nothing, a watery substance. The price I paid was an emotional roller coaster that I wouldn't wish on anyone. I believe breast cancer diagnostics has become in some ways a cottage industry whose ambition, while noble has reached a point of diminishing returns.
51
For those women stating they*d be dead now had they not had earlier-age mammograms: I*m glad your cancer was caught early.
What about the women for whom repeated radiological exposure of sensitive breast tissue triggered the growth of cancerous cells? Is it really surprising that after decades of mammograms, so many women are finally diagnosed with cancer?
At 65, I have never had a mammogram. After years of needle aspirations of cysts, my mother had a simple mastectomy in 1984 with no node involvement and was advised chemo and/or radiation were unnecessary. She endured 25 years of six-monthly mammograms, needle biopsies and excisions on the other breast, was eventually put on drugs to *reduce the chance of cancer,* and died at 87 not from cancer, but from the consequences of side effects of one of those drugs.
I do my best to live a healthy life; I take the nutritional supplements that I know, by lifelong experience, help me to feel better, beat back infections and inflammation, and have no dangerous side effects or track record. I also know that in many, many instances, avoiding serious disease is really a crap shoot. Do what your own best judgment and intuition tells you; do your own research and evaluate for yourself what guidelines seem reasonable; don't trust that doctors channel the words of God for us helpless mortals.
None of us can avoid death, eventually. How much medical intervention do you want in your life before then? You have the right to decide.
What about the women for whom repeated radiological exposure of sensitive breast tissue triggered the growth of cancerous cells? Is it really surprising that after decades of mammograms, so many women are finally diagnosed with cancer?
At 65, I have never had a mammogram. After years of needle aspirations of cysts, my mother had a simple mastectomy in 1984 with no node involvement and was advised chemo and/or radiation were unnecessary. She endured 25 years of six-monthly mammograms, needle biopsies and excisions on the other breast, was eventually put on drugs to *reduce the chance of cancer,* and died at 87 not from cancer, but from the consequences of side effects of one of those drugs.
I do my best to live a healthy life; I take the nutritional supplements that I know, by lifelong experience, help me to feel better, beat back infections and inflammation, and have no dangerous side effects or track record. I also know that in many, many instances, avoiding serious disease is really a crap shoot. Do what your own best judgment and intuition tells you; do your own research and evaluate for yourself what guidelines seem reasonable; don't trust that doctors channel the words of God for us helpless mortals.
None of us can avoid death, eventually. How much medical intervention do you want in your life before then? You have the right to decide.
197
SCA I totally agree with you. No mention in the article of the radiation exposure risk, which as you stated can under the right circumstances trigger cancer. Radiation exposure is not a minor risk for many with a genetic predisposition for breast cancer. Perhaps we will someday have a test that does not involve risk of radiation exposure nor false positives. A blood test is being developed in the UK for detecting breast cancer. I hope it proves successful.
3
Agreed, except maybe the part about supplements. Eat well, excercise, and leave the rest to fate.
1
No cancer patient knows for sure that they were "cured" of cancer by the treatments (i.e., spared a death from breast cancer). The surgery may help some. Chemotherapy and radiation help even fewer women, and harm many. But we don't know which women are at most risk of dying from breast cancer, and then which of those were actually helped by the treatments. It's a great unknown for each individual.
3
Four comments:
1. Now we know why insurers are so anxious to include a free mammogram -- there are only a few required in a woman's lifetime now.
2. Can't believe how much money I've spent on these from age 35, especially when each one required an ultrasound to clarify and most then required a biopsy which was always negative (and the whole thing cost about $1700 --$450 for xray, $400 for ultrasound, $850 for ultrasound-guided biopsy). Until a few years ago, all of this cost was borne by the patient. Now, insurers only cover the initial mammogram IF and only if there are no findings, otherwise it is considered diagnostic and not preventative. Once a calcification might be seen and further testing required, the patient shoulders the cost, both financially and emotionally.
3. No more "clips" placed in breast after biopsy. These clips tear through tissue sometimes causing intense pain and explanting them can cause deformities.
4. Less radiation for mother.
Cancer is the one thing we do not have in my family yet each year, since age 35, my gyn would scold me if I didn't get the annual mammo. I finally stopped doing this 10 years ago when I realized how much radiation I was getting from the occasional 64-slice CT scan (done for other reasons). Had to change Gyn's because I was becoming a "bad" patient.
1. Now we know why insurers are so anxious to include a free mammogram -- there are only a few required in a woman's lifetime now.
2. Can't believe how much money I've spent on these from age 35, especially when each one required an ultrasound to clarify and most then required a biopsy which was always negative (and the whole thing cost about $1700 --$450 for xray, $400 for ultrasound, $850 for ultrasound-guided biopsy). Until a few years ago, all of this cost was borne by the patient. Now, insurers only cover the initial mammogram IF and only if there are no findings, otherwise it is considered diagnostic and not preventative. Once a calcification might be seen and further testing required, the patient shoulders the cost, both financially and emotionally.
3. No more "clips" placed in breast after biopsy. These clips tear through tissue sometimes causing intense pain and explanting them can cause deformities.
4. Less radiation for mother.
Cancer is the one thing we do not have in my family yet each year, since age 35, my gyn would scold me if I didn't get the annual mammo. I finally stopped doing this 10 years ago when I realized how much radiation I was getting from the occasional 64-slice CT scan (done for other reasons). Had to change Gyn's because I was becoming a "bad" patient.
53
Thanks for saying it so well - my experience also. It has been extremely frustrating.
2
Thank you for mentioning #2. I just had my first Mammogram and was called in for a follow up and received a bill for $1200 only to be told all was well. It all felt like a giant scam.
4
I can't help thinking there is a financial angle to this. I had my first routine screening mammogram last month at age 43. The new health laws mandate that insurance companies pay for routine mammograms for women 40-plus. I got called back because of calcifications, and something suspicious, and went in for a diagnostic mammogram during which they took 6 or more images plus an ultrasound. I also have heterogeneously dense breasts which raises my risk and makes it difficult to detect a tumor on mammogram. I found out that insurance companies do not cover the cost of diagnostic mammograms (the additional images required for further evaluation of a suspicious abnormality). Is it possible that more woman in the 40-49 age group went in for their routine mammos now that it is covered by insurance, got called back for further testing (the younger you are the denser the breasts), and ended up getting billed for the additional tests and were unable to pay those bills? Probably. And that puts a burden on the health care industry and ACS changes its recommendations. Furthermore, although dense breast tissue is a definite risk factor, in addition to making it difficult to spot a tumor on a mammo, none of the organizations can decide what kind of additional testing is needed for women with this condition. Radiologists won't recommend supplemental ultrasound because of a higher false positive rate. That may be one reason, but it is also a fact that they get paid very little for ultrasound.
11
Sad to say, I'd probably be wracked with worry during that second year of "grace." Three of my low/no risk friends diagnosed in the last 18 months, so it feels as if one is just waiting one's turn. We need cures yes, but I wonder how much effort is going into finding causes? That's the elephant in the room.
12
A step in the right direction for the ACS. Screening mammography does have some benefit, but it is a relatively poor screening test that leads to massive overdiagnosis. Thousands of women getting chemo and radiation (both of which cause cancer and heart disease) for tumors that never would have progressed? No wonder screening mammography has never been shown to improve overall mortality -- it has the ability to harm (via overuse in low-risk populations) more than it helps.
54
What about making mammography better: higher specificity. Right now, there is NO other better test than mammography in breast cancer detection. It has saved many lives albeit destroyed some. Now, let's make it better to be even more life-saving and less destructive, instead of gradually eliminating it while we have yet nothing to replace.
22
No one gets chemotherapy for DCIS - if they do it is a criminal act. Radiation is given for patients with DCIS, but a good, honest radiation oncologist will tell a woman what the actual benefit is in her case - and often that will lead to people declining therapy appropriately.
The real issue at hand is over-diagnosis and all of its negative implications. Those essentially include anxiety for patients, costs for patients and society (every needless test raises everyone's premium), and ultimately the potential for harm without the potential for benefit.
I applaud the ACS for designing more elegant guidelines that still respect the personalized nature of health and medicine. I'm sure they will be met with some serious resistance from politically motivated groups, but over time they will be accepted by patients, doctors and society as a whole as very evidence based, thoughtful and reasonable.
The real issue at hand is over-diagnosis and all of its negative implications. Those essentially include anxiety for patients, costs for patients and society (every needless test raises everyone's premium), and ultimately the potential for harm without the potential for benefit.
I applaud the ACS for designing more elegant guidelines that still respect the personalized nature of health and medicine. I'm sure they will be met with some serious resistance from politically motivated groups, but over time they will be accepted by patients, doctors and society as a whole as very evidence based, thoughtful and reasonable.
2
There is a newer technology called 3-D mammography. More sensitive and can identify abnormalities in the breasts. However, that too has risks: higher exposure to radiation, expensive and not available to many women. New guidelines does not mean stopping advances in screening tools, just better data from all the tests results.
1
Thank you but if I had followed the new guide lines and had a mammogram every two years after the age of 55 I would be dead. I had no history of cancer in my family and I had no lumps in my breast. I had taken hormone replacement therapy, however. I also had been exposed to many carcinogens in my career as a biophysicists, e.g. benzene, methotrexate, steroids and epidermal growth factor. My cancer was very aggressive and doubled in size in 3 weeks between the first digital mammogram and the biopsy. Fortunately woman are no longer taking the same estrogen replacement drugs, but it may be too early to discontinue yearly mammograms even in woman who have gone through menopause.
11
As you probably know, breast cancer is not one but rather a family of diseases, with a number of associated risks. The most sensible thing for any woman - especially one with a family history of the disease - is to have her DNA profiled at an early age, a process that is 100% risk free. Then, if an inherited risk is indicated, screening mammograms can commence earlier.
There are a number of factors that the community tries to take into account in coming up with guidelines, which incidentally are only that. From my own point of view, cost should not be important, but it is a factor they weigh heavily. Another factor is the risk of false positives, resulting in needless suffering, and even some deaths. But to me the most important consideration is the increased risk of cancer that results from the mammography procedure itself. In the health physics community there is a longstanding debate as to whether there is any level of ionizing radiation that is "safe". Given that nobody except the people who run nuclear power plants claim that there is a safe level of radiation exposure, it is best to avoid x-rays if possible, and, in deciding on a procedure, weigh the comparative risks taking into account other factors. If you are overweight, a smoker, and have a family history of breast cancer. you should probably accept the risk of x-ray induced cancer and start your mammograms early.
I am not a licensed physician.
There are a number of factors that the community tries to take into account in coming up with guidelines, which incidentally are only that. From my own point of view, cost should not be important, but it is a factor they weigh heavily. Another factor is the risk of false positives, resulting in needless suffering, and even some deaths. But to me the most important consideration is the increased risk of cancer that results from the mammography procedure itself. In the health physics community there is a longstanding debate as to whether there is any level of ionizing radiation that is "safe". Given that nobody except the people who run nuclear power plants claim that there is a safe level of radiation exposure, it is best to avoid x-rays if possible, and, in deciding on a procedure, weigh the comparative risks taking into account other factors. If you are overweight, a smoker, and have a family history of breast cancer. you should probably accept the risk of x-ray induced cancer and start your mammograms early.
I am not a licensed physician.
2
Doesn't HRT put you outside the "low risk" category, in any event? And certainly your occupational exposure should do so - yes?
3
The so-called facts of mammography never added up for me, so I never bothered to have a mammogram.
I'm now three years past the 45-to-54 window and I continue to feel justified in never being screened this way, having judged the risks for myself.
If I do develop breast cancer at some point, I won't blame myself for being reluctant to use expensive testing equipment. Life is a daily roll of the dice and I'll simply hope that the advancement in treatments will be effective. Those who have been saved by mammography remain in the lucky minority, but they're a minority nonetheless.
I'm now three years past the 45-to-54 window and I continue to feel justified in never being screened this way, having judged the risks for myself.
If I do develop breast cancer at some point, I won't blame myself for being reluctant to use expensive testing equipment. Life is a daily roll of the dice and I'll simply hope that the advancement in treatments will be effective. Those who have been saved by mammography remain in the lucky minority, but they're a minority nonetheless.
62
My understanding is that having fatty as opposed to dense breasts also puts a woman at a lower risk of developing breast cancer. This is such an important piece of the puzzle that New York State now mandates that mammogram reports include this information: dense or fatty breasts.
10
Fatty breasts (generally in older women) are easier to detect aberrant tumors in with mammogram. Dense breasts (younger women) can make it harder for mammogram itself to pick up a contrasting mass within normal tissue.
2
Please note that the dense breasts diagnosis is not limited to younger women; it is also an occurrence among older women.
5
The guidelines never made any sense to me. Mass screening should not be done for people with no risk factors.
76
Many medical tests are prescribed at ridiculously high frequencies. The reason is cash. They made boatloads of money testing every woman in society every single year for several decades. This exact problem can be seen in many other tests such as prostrate tests for men. A very high frequency of different tests provides a large cash flow to doctors. End of story.
As a parallel, when EPA checks of cars began they tested every single car every single year. Sure you just bought a brand new Chevy, it has zero risk of not passing emissions. But you were socked with the fee anyway. Only many years later did they stop testing new cars, and they cut the frequency to every other year.
But in not one of these cases is anyone going to refund us for the money we wasted. There is no shortage of scams going on. Everyone is out for the buck.
As a parallel, when EPA checks of cars began they tested every single car every single year. Sure you just bought a brand new Chevy, it has zero risk of not passing emissions. But you were socked with the fee anyway. Only many years later did they stop testing new cars, and they cut the frequency to every other year.
But in not one of these cases is anyone going to refund us for the money we wasted. There is no shortage of scams going on. Everyone is out for the buck.
12
AA said: "The guidelines never made any sense to me. Mass screening should not be done for people with no risk factors." AA, join a facebook breast cancer group and tell that to thousands of young women who are diagnosed yearly with no family history nor symptoms. Is it okay for them to die with no screening? As long as science has no proper blood test to detect breast cancer, as many women as possible should be screened.
3
There was NEVER a mass screening, AA. It was believed that women starting at age 40 with a higher risk for breast cancer should have mammography done yearly. Now the age is increased to 45. The risk factor now, based on age, is changed to 45, instead of 40.
4
This article has infuriated me. I would also be dead with these recommendations. As it is - the previous recommendations didn't help me much. I was diagnosed with stage 2 IDC at the age of 37 before anyone would have sent me for a baseline mammogram. Thanks goodness my gyn had the sense to do a clinical breast exam and send me with scripts for not just a mammo, but also a sono. My mammo found nothing. But my sono found what he knew he felt. And it was already in 6 nodes by the time they found it. So now they say the 5-6 minutes a clinical breast exam takes is not worth it and could be better spent. Better spent doing what I ask?!!! And as for their comments about younger women being at less risk of dying - that is bull. They should spend some time on the online support boards for women under 40 with breast cancer and see what they learn there. Ridiculous!
69
Please try not to be infuriated by SCIENTIFIC and medical findings. These findings are based on large numbers, not personal anecdotes, because anecdote is not data. There are thousands of women as infuriated as you from having gotten false positives or made to go through unnecessary biopsies. They count too.
129
The thousands of women "infuriated" by false positives and biopsies won't die from the inconvenience. I am chiming in to say I too would be dead without the "unnecessary" mammogram-- sorry but death is a bigger pill to swallow than inconvenience and worry.
8
if your mammogram found nothing, only the sonogram, why is that an argument for having mammograms?
38
"Dr. Keating, who practices at Brigham and Women’s Hospital in Boston, said doctors and patients had clung to the practice of early and yearly mammograms out of fear that they would otherwise miss detecting a cancer."
Fear seems the operative word here. A bold position for the ACS and relief, I hope, for millions of women.
Fear seems the operative word here. A bold position for the ACS and relief, I hope, for millions of women.
61
Fear seems the operative word here.
You bet it is. I believe fear of cancer will cause cancer.
"Do not fear" is the most used verse (365 times) in the Bible.
You bet it is. I believe fear of cancer will cause cancer.
"Do not fear" is the most used verse (365 times) in the Bible.
2
What are the implications of this for insurance coverage? It took long enough for mammograms to be recognized as necessary medical attention for women, rather than "preventive medicine" (which, as a false economy, is not covered by many health insurers). Now will insurers cut back on coverage: none before age 45, and then only every two years after that? It should be a woman's choice to have more testing, particularly if, like me, she is in a broad higher-risk category (Ashkenazi Jew) but has no particular family disposition to breast cancer.
18
No. These are guidelines for doctors and patients, not a mandate for insurance companies. And if an insurance company were to try to raise the screening minimum age for coverage, you can bet the public would raise such a hue and cry that the company would reverse course quickly.
In computer technology: Something is imperfect, make it better
In business: Something is expensive, make more of it and cheaper.
In security: Something is unsafe, make it safer.
In education: Something is unknown, learn more.
Only in health care: Something is imperfect, do less of it. Something is unsafe, do less of it. Something is expensive, do less of it. Something is unknown, do less of it.
Come on, people; it was PSA, cervical PAP, physical exams, Xrays, now mammograms. Do less, and less and less. Why innovate, then use less. Whatever happened to: We will make it better, safer, and cheaper?
In business: Something is expensive, make more of it and cheaper.
In security: Something is unsafe, make it safer.
In education: Something is unknown, learn more.
Only in health care: Something is imperfect, do less of it. Something is unsafe, do less of it. Something is expensive, do less of it. Something is unknown, do less of it.
Come on, people; it was PSA, cervical PAP, physical exams, Xrays, now mammograms. Do less, and less and less. Why innovate, then use less. Whatever happened to: We will make it better, safer, and cheaper?
43
Actually you are correct. In medicine frequently doing less is better medicine. The reason for this is that when something small is discovered no one has any idea what to do so they frequently amputate, operate and do a variety of other things that have catastrophic side effects. More and more research is showing that the body can deal with many small cancers or the cancer simply stays there and does not grow and you live with the cancer for decades without any problem whatsoever. If treatments had no side effects that would be on issue but the fact is that many people have had their lives destroyed by treatment and it would appear that many people with small cancers ned no treatment at all. The announcement is a move in the right direction. The fact is that the research in this area is very clear, mammograms have little to no beneficial impact when done as a screening tool. The fact that PR tells you otherwise does not change the facts. Mammograms destroy many more lives than they save. They do help with diagnosis when there is something to actually check out.
14
"Something is unsafe, do less of it" sounds about right to me.
5
"Something is imperfect, do less of it. Something is unsafe, do less of it"
But it makes sense to do less of something that isn't good or safe. That doesn't mean more research isn't being done to make it better.
But it makes sense to do less of something that isn't good or safe. That doesn't mean more research isn't being done to make it better.
4
I'd be dead with these guidelines. Poor recommendations!
23
Me too! Very aggressive cancer at 37, with no known risk factors other than being female.
7
Just wondering: did you have a genetic profile done? There are gene markers for a number of forms of breast cancer that would show up in a $100 test that involves no health risk.
I wish the ACS would recommend that all women have their DNA profiled. It would enable care givers to tailor their recommendations based on a more accurate assessment of risk. But unfortunately we live in a society so rife with ignorance that organizations feel compelled to offer one size fits all solutions.
I wish the ACS would recommend that all women have their DNA profiled. It would enable care givers to tailor their recommendations based on a more accurate assessment of risk. But unfortunately we live in a society so rife with ignorance that organizations feel compelled to offer one size fits all solutions.
2
If I were a woman I would not rely on genetic testing alone. Currently genetic testing is not good enough to tell a woman if she is at increased risk for breast cancer unless it detects one of two mutations known as BRCA1 and BRCA2 mutation. Many women get breast cancer that have no known genetic reason for their breast cancer and genetic testing would have done them no good. Genetic testing has a long way to go befor it is able to help us determine risk from many diseases.
....Which my INTUITION always told me, and thankfully I followed it, along w/my daughter. BILLIONS of dollars donated to research, maybe TRILLIONS by now, and they're just coming out with this? Long ago I turned a jaundiced eye toward the "cancer industry." Saw them come out of the woodwork w/calls for donations when my sister was diagnosed. Pathetic.
134
I agree with you on the "cancer industry". The money is in treatment, not cure. But what is the alternative? When I was diagnosed I was force to put my life into the hands of medical professionals and the drug protocols they had in their arsenals. Things have changed since then (2003) and perhaps I would not get the same chemotherapy drugs today. But we go with the best knowledge we have at the time and the best doctors we can find when faced with death. I note that this article does not mention what CAN be done to detect cancer...so until it is visible to the naked eye it will go untreated. Which means there will be more deaths but not until the patient is subjected to stronger more gruesome treatments. Hardly a step forward.
6
Yup - just follow the money. Billions to be made by manufacturing mammography machines, and staffing mammography centers and hospitals.
8
goes on to emphasize how little is gained. It leaves the impression that it's not necessary for anyone. And that's dangerous!