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What is this?
New breast cancer standards are dangerous
Published Friday, November 27, 2009
To the editor:
I’m submitting this letter on behalf of two physicians: Kelley Allison, M.D., a radiologist specializing in breast imaging, and Richard Hoefer, D.O., a surgical oncologist. They are co-medical directors of the Dorothy G. Hoefer Comprehensive Breast Center.
As physicians who treat and care for breast patients every day, we are deeply alarmed by the new recommendations for breast cancer screening from the U.S. Preventive Services Task Force.
There is universal agreement in the medical community that screening mammography saves lives. Women who undergo screening mammography decrease their chance of dying from breast cancer by 30 percent. Any change in the current screening recommendations would only reverse that trend and cause direct harm to women’s health.
Let us stress that the Task Force recommendations are a reinterpretation of 1980s data using analog mammography machines. Today, digital mammography is widespread and a much more powerful tool for detecting breast cancer in younger women.
The task force failed to consider more recent studies, such as one published in the New England Journal of Medicine in 2005 by Dr. Etta Pisano in which digital mammograms were found to be more effective when used to screen for breast cancer, specifically in younger women with dense breasts.
Despite the Task Force recommendation against them, self breast exams are the easiest free test around that could save lives. In addition to self breast exams, we strongly urge women and their physicians to follow the American Cancer Society guidelines of yearly screening mammography beginning at age 40
During the last year alone, more than 250 women in their 40s were diagnosed with breast cancer within the Sentara Cancer Network. These women are raising children, working, and caring for their parents. These women matter.
Nearly 20 percent of all breast cancer cases found nationally and within the Sentara system occur in women ages 40-49. Frequently, younger women are diagnosed with more aggressive cancers. The recommendations of this task force would put younger women diagnosed with breast cancer at greater risk of death.
A full 56 percent of all breast cancer cases are detected at stage 0 and 1 (the earliest stages for diagnosing cancer), according to the National Cancer Data Base. At these early stages the five-year survival rate approaches 100 percent. By delaying screening mammograms 10 years, from age 40 to 50, breast cancers will be detected at later stages, when mortality rates are higher.
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Posted by HipHopRockzMagazine (anonymous) on November 27, 2009 at 10:13 p.m. (Suggest removal)
This is why women need to make their own decisions about their life and not allow others to determine what they should do. If one doctor won't perform the mammogram move on to the next one! You only have one life to live! Do not give others power over it!
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Posted by ignoranceisalearnedbehavior (anonymous) on November 29, 2009 at 10:44 a.m. (Suggest removal)
The 30% figure mentioned above relates to what, exactly? 30% in the age-group 40-50? This has a strong odor of fear-mongering without talking about how many people will actually die as a direct result of the changes (if followed); the annual answer, according to the research, is about 680. I'm not saying this is not a significant number, but where you could possibly find a figure for a 30% risk of death increase in this age-group intrigues me.
Rarely are actual numbers reported. The published figures seem to indigate that for a portion of the group for whom the annual routine test is no longer recommended, the digital is 11% more successful (other groups up to 16%). So no routine testing leads to an extra 680 deaths a year (according to the data) compared to routine testing (ignoring all the false-positive, over-treatment numbers, many of which are also 7 figure; there are about 22 million age 40-50 women in the country 10% of tests or more produce "false positives"). If ALL exams were done digitally, at an increased detection rate of 11% would that not yield an extra 74 lives? At 16%, 109. From a screening group of millions?
I wholeheartedly agree that better testing is needed, but an 11% increase on a rather inefficient test is of little *numeric* significance. Even at a 16% improvement this could be debated. And, to be cynical, at what cost increase?
You state correctly that, " By delaying screening mammograms 10 years, from age 40 to 50, breast cancers will be detected at later stages, when mortality rates are higher" but you don't give any numbers. An extra 6800 people will die per decade, and tens of millions will avoid false positives, unnecessary biopsies etc. and somewhere in the region of $10 billion (at $50 / exam) and $40 billion ($200/exam) will be saved (most likely directly by the group, "women aged 40-50").
Personally I'd spend the money, have the test, put up with the grief that comes with its inaccuracies, but the whole thing of "informed consent" comes in to play rather strongly here and as already said, one does not read much in the media about the actual numbers.
Posted by OD (anonymous) on November 30, 2009 at 9:11 a.m. (Suggest removal)
preventive medicine is cheaper than treating a disease.
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