Mammogram guidelines face local criticism

Marvella Ford

Marvella Ford was surprised to learn after her annual mammogram at 43 that she had early stage breast cancer.

But the prognosis her doctor gave her was good: There was a 98 percent chance she would not die from the disease. And nearly two years later, after a lumpectomy and radiation, Ford is cancer-free.

So this week, when the Charleston resident heard about new breast cancer screening recommendations from a government task force, she was appalled.

The panel stated that most women should wait until 50 to get mammograms, and then they should have them every two years. For nearly two decades, the American Cancer Society has recommended women begin having annual mammograms starting at 40.

"I think what's disturbing is the fact that if those guidelines had been followed for me, my breast cancer would not have been discovered at such an early stage," said Ford, who has no family history of breast cancer. "And we know that breast cancer is highly treatable when it's discovered early, and the earlier it's discovered, the less invasive the treatment options are. ... Under the new guidelines, a tumor could have formed and grown, and I might not have made it to the age of 50."

She isn't the only one upset about the mammography guidelines from the U.S. Preventive Services Task Force. Multiple national groups have come out with statements strongly opposing them, including the American Society of Breast Imaging, American College of Radiology, National Comprehensive Cancer Network, American Cancer Society, American Society of Breast Surgeons, American Society of Breast Disease and Susan G. Komen Foundation.

On Wednesday, Health and Human Services Secretary Kathleen Sebelius moved to quell the confusion by saying that her agency's policy would not change, and that women should continue to get mammograms at 40. She was careful to point out that task force recommendations do not set government policy.

"Indeed, I would be very surprised if any private insurance company changed its mammography-coverage decisions as a result of this action," she told The Associated Press.

The National Cancer Institute issued a statement recommending individuals consider the benefits and risks and discuss the issue with their health care providers. The institute said it has had "screening recommendations for many years, and ... more questions need to be answered."

Local physicians also are voicing their concerns.

Dr. Megan Baker Ruppel, medical director of Comprehensive Breast Care at the Hollings Cancer Center, called the recommendations "incredibly disappointing" and said it was a backward move in terms of compliance with mammograms.

"This is going to cause tremendous confusion," she said. "And one of the greatest successes of our ability to detect and treat and decrease the mortality of breast cancer has been in the simplicity of the screening recommendations. The American health care system is not set up in any way, shape or form to deal with complex screening recommendations.

When we do those types of recommendations, the screening doesn't happen."

The report states that early and frequent screenings often lead to false alarms and unnecessary biopsies without substantially improving women's odds of survival. It states that mammography for women ages 40 to 49 decreases mortality by 15 percent.

Ruppel said she doesn't dispute the data in the report, which she says is nothing new. What she and other critics disagree with is the cost vs. benefit.

"We think that 15 percent (that survives) matters, even at a greater cost," she said. "The notion that we're going to sit by and let breast cancers become more advanced while we neglect them, it's just not tenable."

Dr. Jennifer Cranny, mammographer with Charleston Radiologists, said many women in their 40s develop breast cancer, and that at that age, the cancer tends to be more aggressive.

"I think it's a very dramatic statement, and it's unfortunate that they (women in their 40s) wouldn't be considered a worthy population to screen when, really, they offer more to society and to their family," Cranny said.

She and Ruppel also disagree with the panel's recommendation to stop teaching women to do self-exams, as they are free, nonintrusive and easy to teach.

Discouraging a woman from being knowledgeable about her own body "is really irresponsible," Ruppel said.