Women in 40s advised against routine annual mammograms

[NNN0LHI]

Damn, and I have been on my wife to go get one lately. The lack of her getting one has been worrying me. Now I read this?

http://www.chicagotribune.com/features/health/chi-091116mammograms,0,6861944.story

By Judith Graham

Tribune staff reporter

4:00 p.m. CST, November 16, 2009

In a highly controversial move, an influential government-sponsored organization is recommending against routine annual mammograms for healthy women in their 40s.

After re-evaluating scientific research on mammography's ability to reduce deaths from breast cancer, the U.S. Preventive Services Task Force says these women should consult a physician and make a decision reflecting their own preferences and values. The recommendation does not apply to women at high risk for the disease.

The group had previously suggested that women age 40 to 49 be screened for breast cancer every one or two years.

"No one is saying that women should not be screened in their 40s," said Dr. Diana Petitti, vice chair of the task force, whose work is closely followed by doctors and insurance companies. "We're saying there needs to be a discussion between women and their doctors."

The new advice reflects a heightened appreciation of the potential harms associated with breast screening. No one disputes that mammograms help save lives, but they can be unreliable, identifying too many benign growths as cancerous, missing other tumors that are malignant, and sometimes leading to medical interventions of questionable benefit, experts note.

[Haole Girl]

1. "...potential harms associated with breast screening"

:wtf:

[NNN0LHI]

3. My wife says its painful as hell and thats why I didn't push it

She told me to go get one myself and check back with her and let her know how it felt.

My wife is quite the kidder.

Don

[liberalhistorian]

7. See, with all due respect to your wife, I don't really understand

that. I've had several mammograms and they haven't really hurt. They're a little uncomfortable, sure, and it's not a walk in the park, especially considering that I'm very, uh, well, shall we say VERY well-endowed. But even if it WERE painful, I'd rather deal with that than the pain of later-stage cancer that wasn't discovered in time.

[Arugula Latte]

12. I've heard that smaller-breasted women tend to experience more pain.

I'm fairly amply endowed myself and have never had it hurt, but I don't doubt it does for some/many women.

[JerseygirlCT]

29. That makes sense

Think about all the squishing to be done. Like you, I've got more than I'd like, but manipulating smaller breasts into place and flattening them out, etc... yeah, I imagine that would be pretty uncomfortable.

[JerseygirlCT]

28. As I've gotten older, they've definitely gotten more painful.

But as you say, it's short-term pain.

[Hell Hath No Fury]

51. Smaller, polycystic, dense breasts here --

Mammies hurt like motherfucker for me -- almost to the point if Passing out. :shrug: My Mom has ginormous, fatty boobs and she has had nary a problem all these years.

It just depends on each woman.

[gkhouston]

55. Breasts differ. And some techs squish a LOT harder than others. In general,

they don't press down as hard as they did 15-20 years ago. The "super squish" (my terminology) is now reserved for the callback they call a "spot compression" which is usually followed by an ultrasound, anyway, so why not skip the torture and go straight to the ultrasound?

[amborin]

67. not my

experience

the super squish is common where i go

[emilyg]

8. It's not. I've had quite a few.

[Lars39]

9. It helps to take some ibuprofen about an hour or so before you have one done.

[Haole Girl]

10. It is painful as hell...

but early detection is the key to saving lives when it comes to cancer.

I question the source and motive(s) of this new recommendation.

[dana_b]

11. I find it very painful too

and every other year sounds good to me!

[Berry Cool]

26. It is not all about "early detection." Don't believe the hype.

If your cancer is fast-moving and aggressive, early detection doesn't necessarily do a lot of good.

If it's slow-moving and lazy, yes, it can help.

And early detection does give you more treatment options.

But early detection, all on its own, does NOT save lives. It helps some people treat their cancer more effectively. But that's all it does.

[Haole Girl]

27. I'll take regular screening

I have a great aunt who died from breast cancer.

[a la izquierda]

44. Me too, thanks very much.

My maternal great-grandma had two mastectomies in her lifetime.
My maternal grandma had a double mastectomy.

I'm 32, and the idea of breast cancer scares the hell out of me. My doctors (GP and OB/GYN) are all over me about self-exams, until I turn 40 (they ask every time I'm in, even if it's for a med consult). I'm grateful for them.

[amborin]

37. not quite! early detection for "fast-moving, aggressive" can give one 1-2 yrs survival!

[momto3]

43. Sorry - but this is wrong.

Early detection, especially in the case of breast cancer, saves many lives. Yearly mammograms/ultrasounds are not enough. Women must perform monthly self exams. Even aggressive cancers, if caught early enough can be stopped. If the tumor is caught before it reaches the lymph nodes, surgical removal of the breast is a very effective way of stopping the cancer. There is no guarantee that the cancer will not recur. My grandmother died from recurring breast cancer 20 years after her original diagnosis. But, she lived 20 pretty fantastic years that she would not have had if her tumor would not have been caught early. My Mom has been breast cancer free for 8 years now due to the diagnosis from a mammogram. Her case was particularly difficult since she also had fibrocystic disease of the breasts. Without her mammogram, she would be dead.

Screening has also been very effective for decreasing the mortality due to colon cancer. I find it very frustrating to hear people dismiss "early detection" screening. It does give more treatment options, but its end result is that it does save lives. Posts like these may turn women away from screening. That is irresponsible and wrong.

[mainer]

13. It hurts like hell -- but I think more so for women with smaller breasts

I found myself avoiding them for as long as possible. Because it's so darn uncomfortable.

The smaller the breasts, the harder they have to squeeze to get enough breast tissue onto those plates.

[blueamy66]

41. I blacked out the first time I had one....

and haven't been back since.

[gkhouston]

56. Doctors have a tendency to push biopsies over watchful waiting. I got MRSA

from a biopsy several years ago. I now have two ugly scars on one of my breasts. Guess which choice I'll be making next time.

[OnceUponTimeOnTheNet]

2. "We're saying there needs to be a discussion between women and their doctors."

Looks to me more like a Discussion between my Doctor and the Insurance industry.

[liberalhistorian]

5. Exactly. THAT is what this is all about.

Putting women's health at risk for the benefit of the insurance industry. Period. And doctors who go along with it KNOWING that that is the case make me sick.

[liberalhistorian]

4. I'm sorry, but I strongly disagree with this.

I'm almost 45 and most of my friends are around the same age, give or take a few years. I have four friends who got breast cancer in their mid to late 30's, cancer that would never have been discovered in time had they not insisted on beginning mammograms at 35, AGAINST what their doctors wanted to do because the docs simply thought they were "too young" and "nothing would happen" to them. One was even called "hysterical" and "dramatic" because she insisted on a mammogram at 36. Well, guess what? Her very first mammogram showed cancer and not a small tumor, either. Plenty of women now get breast cancer before forty, some well before forty and some even in their twenties. And many have no known risk factors. I think this "recommendation" is dangerous and will take us backwards.

[ohheckyeah]

6. False positives are a very real problem

with mammograms and many women are having biopsies needlessly....especially younger women. My own mother had a mastectomy for a breast cancer they now know does not ever spread outside the milk duct and is basically harmless. She wasn't real happy to find that out a couple of years after having a breast removed.

Personally, I think mammograms are dangerous and should be replaced with ultrasounds..

I heard something odd from a doctor being interviewed on the news....she said "we aren't trying to take away your right to be irradiated." What a strange way to phrase that.

[momto3]

14. It is the risk from the radiation exposure from the mammograms that is the concern.

This concern has been discussed in the radiation biology field for many years. No one is disputing the value of the mammograms as a diagnostic tool. But if a woman is predisposed to cancer, often due to a genetic defect in a DNA repair mechanism, is it wise to regular irradiate any tissue in that individual? Especially when there are other methods of cancer screening (such as ultrasound) that are equally as effective and much less potentially dangerous.

It is controversial, since the women with familial incidence of breast cancer are the individuals that need early preventative screening and are also the individuals that the radiation from the mammograms may harm the most.

Tracy

[ohheckyeah]

19. Thanks for that.

I just realized I had used the word sonogram instead of ultrasound.

I personally don't think it can be good to compress a body part and irradiate it and I think ultrasound should replace mammograms.

[amborin]

46. no

VERY little radition from mammograms!

[WolverineDG]

21. That's the reason my doctor gave for not scheduling one

last year....no family history plus none of the others I'd had ordered by my previous doctor showed anything.

dg

[momto3]

40. The trend is changing.

From what I am hearing, most docs would like a baseline mammogram during the late 30's to early 40's for women with no family history of breast cancer. Then yearly or bi-yearly mammograms after menopause. Of course, monthly self exams and yearly exams with a gynecologist are still important.

Of course this is a self-defeating circle, since the women with a family history of breast cancer need mammograms yearly starting at 40 (or so). This of course leads to the higher radiation exposure for these women. This is why I feel that mammograms should be replaced with ultrasound.

BTW - This is personal for me. My Mom was diagnosed with breast cancer 8 years ago and had a bilateral masectomy performed. I am 40 years old and dealing with my own concerns of mammograms and radiation exposure, both from the perspective of a patient, a family member and a scientist in the field.

Tracy

[amborin]

36. not so! the radiation is very miniscule; it's CAT scans that load you up, not mammograms

[momto3]

39. You are correct - CAT scans give off a much higher dose of radiation.

And, the amount of radiation from mammograms is small. Additionally, the risk of harm from mammograms is extremely small, for most women. But - if one is already predisposed to cancer, or has a defect in a DNA damage repair pathway, even a little bit of radiation is too much. You are correct - CAT scans give off a much higher dose of radiation.

The problem arises from the fact that there is little to no way to determine if a woman would be predisposed to develop cancer from a small amount of radiation exposure. And since ultrasound can work just as well, without the risk of radiation, why not use it instead?

Tracy

[doc03]

15. That is one stupid, dumb a-- move at this time. The Repugs are

going to jump on this like flies to crap calling it the government rationing health-care. My Republican neighbor was at my house when we heard the report on NBC news, that was the first thing came to his mind, there they go rationing health-care already. Faux will play that one up to the max.

[betharina]

48. elizabeth hasslebeck was already spewing that idea on the view this morning, nt

[undeterred]

16. So will my insurance company send me a bill

for the unnecessary ones I've already had?

[Horse with no Name]

17. Bullcrap.

This is another gift to the insurance industry. One of many to come, I am quite sure.
Just another reminder that women are expendable.
Fuck that.
Mammograms SAVE lives. Show me ONE that got cancer from getting a mammogram every year and I will eat the fucking machine.

[ohheckyeah]

22. It's pretty hard to determine the exact

cause of some cancers. The fact is, there are safer means of screening, especially for younger women.

[amborin]

47. where are you

getting your info?

what safer methods?

mammograms are VERY safe, very little radation and great imagining with digital

[ohheckyeah]

49. I posted a link.

Not everyone agrees that they are VERY safe.

Here it is:

http://www.yourhealthbase.com/breast_cancer_detection.html

[amborin]

50. well the leading cancer centers think

differently!

believe me, LOTs of things are not totally safe

even aspirin is not totally safe

even lettuce isn't!

they're much safer than a bout of breast cancer!

[ohheckyeah]

52. And there are safer tests, so why take the risk?

Why not demand more accurate, safer and painless tests?

[amborin]

57. they're not as accurate; and the risk from mammograms is miniscule!

[ohheckyeah]

58. Yes, they are accurate.

And not all of the experts agree that the risk is minuscule. Why not use tests that carry NO risks? Why hold onto mammograms as if they are somehow sacred? Unless of course someone gets paid to do mammograms.

Mammograms are terribly inaccurate, which is the whole point of this recommendation. For us to hold onto a test that many women don't even get because of the pain and that are inaccurate is really just silly. Right this minute we already have better tests...ultrasound and MRIs. I think we should fight to get the very BEST of testing, not cling to the test most often used now just because it's what we've been using.

[amborin]

60. i have read that ultrasounds are not nearly as acccurate

they cannot provide as good an image as a mammogram

and MRIs are way too expensive for mass, yearly screening

[ohheckyeah]

61. and you have hit upon the reason the less

accurate and somewhat risky mammograms are used....mass screening cheaply. I haven't read that ultrasound is not nearly as accurate and the site I linked to had another of other tests that are being used. Mammograms are not accurate which is why there are so many false positives causing so many women to have unnecessary biopsies.

Mammograms are quite painful for lots of women, they are not accurate and they carry some risk. Just because they are cheap and they can herd women like cattle through the mammogram centers is no reason to think they are the end all and be all of breast cancer screening. We need to have numerous options, less painful options and more accurate options. There's no need to settle. It's up to women to demand better.

I wonder what would happen if the only test around for testicular cancer was compressing a man's testicle and irradiating them. I doubt that would be seen as the best the medical community could come up with.

Here are some interesting statistics:

A Dutch study (NEJM 2004; 351: 427-37) found that screening by MRI detected 79.5% of invasive breast cancer, compared to 33.3% for mammography and 17.9% for clinical breast exam. The study screened 1909 women, including 358 who carried gene-line mutations.

A Canadian study (JAMA 2004;292<11>:1317-25) concluded that MRIs were more sensitive and more specific in detecting small breast cancers than mammograms, ultrasounds or clinical breast exams. That study followed 236 Canadian women aged 25 to 65 with BRCA1 or BRCA2 mutations at Toronto's Sunnybrook and Women's College Health Sciences Centre between 1997 and 2003. The women were screened through MRI, mammography, ultrasound and clinical breast exam (CBE) on the same day. Overall, the tests detected 22 cancers. MRIs detected 17 (77%); mammography 8 (36%); ultrasound 7 (33%); and CBE 2 (9.1%).
http://www.cmaj.ca/cgi/content/full/171/8/840

[amborin]

62. well

yes, mammograms are painful, but it's for a very brief couple of minutes

sure, false positives are a pain but i'd rather a false positive than a false negative

and false positives are a small price to pay for catching breast cancer early

MRIs are too expensive for mass screening, surely you agree

[ohheckyeah]

63. False negatives are a problem, too.

Look at the stats above....mammograms only catch 36% of breast cancers. MRS's in the 79% range. MRI's can be made less expensive if there is a push for it. And there are other tests that need further studies and development.

As for the couple of minutes of pain....I'll have to assume you don't have fibrocystic breasts. It's easy to make light of other people's pain. I know many women who have quit getting mammograms because of the pain which makes them a not very effective means of testing.

Mammograms are only slightly more accurate than ultrasound and carry more pain and more risks. Like I said, men would never put up with a test for cancer that compressed the testicles and irradiates them. Why should women settle for mammograms? They are painful, they aren't particularly accurate (having both false positives and negatives) and we don't need to settle for them. If we find the studies in other countries are correct and that mammograms are actually contributing to the rise in breast cancer then they will not have necessarily been worth it. The studies don't appear to be from crackpots and I for one think we ignore them at our own peril.

We need more unbiased studies of the safety of mammograms, we need more research and development of better tests and we need to quit settling like good little girls and demand more.

I think we have been sold a bill of goods with mammograms and we can do better. I know we damn sure deserve better.

[amborin]

65. more...

"Despite some limitations, mammography remains the most effective way to detect breast cancer. It is the only detection method that has been studied in large trials and proven to reduce deaths from breast cancer. So working to improve mammographic images is critical to improving accuracy in breast cancer detection," he says.

Digital mammography uses computers and specially designed detectors to provide a digital image of the breast. This image can be displayed and enlarged, magnified, lightened or darkened on high-resolution monitors. The digital images can also be printed on X-ray film.

"One possible advantage of digital mammography is that it may be more effective in detecting cancers in women with dense breasts because the digital mammogram images have a wider contrast range than images on standard mammograms," Bassett says.

"With standard mammography, radiologists have a more limited ability to spot abnormalities in dense breast tissue or recognize tumors with subtle or faint borders," he says
..."

<http://preventdisease.com/news/articles/which_mammography_works_best.shtml>

[ohheckyeah]

66. and your point is what?

Mammograms still have a high inaccuracy and risk involved. Why is mammography a holy grail? There are other tests that are less painful and we can demand more research and development for better testing. No test works if it's so painful women don't get it.

I noticed you ignored the statistics I posted.

[mcablue]

18. Women should sue those who recommended harmful over-screening

They now act as if nothing happened. As if many women didn't get cancer because of over-screening.
If I were a woman whose cancer may have been the product of excessive screening, I would sue.

[Contrary1]

23. Wouldn't do any good to sue. One would have to prove the cause to prevail...

I started getting regular mammograms when I was 19. Missed a year, here and there, but in total have had between 20 and 25, not counting the episode in the next paragraph.

Now, when I found my own tumor with self exam, the radiologist acted like it was Christmas. Wanted every angle possible. After 12 smashdowns, I refused to do any more. She was actually upset with me.

The breast surgeon who viewed all the films couldn't believe it.

And, for anyone out there who does find a lump or anything else suspicious, this is the best advice I can give you. See a breast specialist, not a general surgeon.

[HipChick]

20. I have had one yearly...I found a lump when I was 19,

and then another at 21...they ended up being benign tumors...but that scare stays with you...
few months back of a co-worker, she had never ever got one in her life, by the time she did, she'd already at a stage III

What about females that may be dispositioned ?

[Desertrose]

24. Squishin' your boobs flat & shooting with x-rays

Not my idea of breast health.

Seems to me we could find a better method to detect lumps etc.
Just sayin'.

[treestar]

25. Oh great, I just left my 40s

When I could have taken advantage of this!

:rofl:

[Sen. Walter Sobchak]

30. I know two women who developed breast cancer in their early 30's

One of them didn't even notice the lump, a man fondling her breasts during sex noticed it - the other had a mammogram at that age because of family history.

This horrifies me,

[Contrary1]

31. Oh My Gosh!!! Look what was omitted from this article!

"...Also, the task force said breast self-exams do no good and women shouldn't be taught to do them.

<snip>

The new advice says:

Most women in their 40s should not routinely get mammograms.
Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)
The value of breast exams by doctors is unknown. And breast self-exams are of no value..."

:wtf:

http://www.msnbc.msn.com/id/33973665/ns/health-womens_health/

[amborin]

45. b/c the lesions are so tiny! the new guidelines are total BS

[Hell Hath No Fury]

54. It is so fucked up --

what are women supposed to do? Wait until their breast cancer is fucking obvious and then just die because it is stage IV??

[ohheckyeah]

32. Here's the link to an interesting website

that shows studies from other countries:

http://www.yourhealthbase.com/breast_cancer_detection.html

[DU GrovelBot]

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[OnceUponTimeOnTheNet]

34. Wait a God damn moment here. From Article...

~The task force also is suggesting that women age 50 to 75 get the X-ray tests every two years instead of annually. There isn't sufficient evidence to recommend screening for women 75 and older, it says.
~end.

My Mom had breast cancer at age 76. 5 years later, after treatment, We still have her.

Just what is it these task force folks are pushing for?

profit profit profit.

[amborin]

35. they *always* urged a "baseline" at 35, then yearly starting at 40 n/t

[question everything]

38. ABC reported it and had a woman who was diagnosed when she was 40

thanks to mammography. She said that had she followed these proposed guidelines, she would not be alive today. And the American Cancer Society does not agree with this.

The problem will be insurance company will now not pay for it.

http://abcnews.go.com/Health/OnCallPlusBreastCancerNews/mammogram-guidelines-spur-debate-early-detection/story?id=9099145

[Mari333]

42. well I just had my boobs checked after 10 yrs, and Im 58

and they are fine. no cancer in my family, I never used birth control pills or took hormones, and I dont eat meat and dairy.
The test is expensive here, tho. If anything , that keeps a lot of women from getting it done.

[seemunkee]

53. NCI and ACS are not changing their views

http://www.miamiherald.com/news/nation/story/1337124.html
Underscoring deep disagreements among medical experts on the issue, the American Cancer Society and the National Cancer Institute said they had no plans to back down from their current positions. The society recommends annual mammograms for women starting at age 40; the cancer institute says every one to two years for that group.

[ohheckyeah]

59. I have to wonder why

they are clinging to a test that is proved to be inaccurate instead of fighting to get better tests.

[quiller4]

64. My own doc recommended I get a baseline at 45 after my sister

found a malignant lump in her breast at 43. That lump did not shown on a mammogram taken before before her surgery. In other words the mammogram missed her tumor even after she detected it.

As our doc explainecd mammograms don't do a very good job of finding tumors in the dense tissue of younger breasts though they can spot tumors of different types in older, less dense tissue quite effectively.

What the new report suggests is that the US adopt the standard of care that is in effect in most other first world countries. My sis and I both go to a doc who trained in Canada. She also treated our late mother. She spent time with all of her patients explaining why she questioned the value of blanket recommendations and took a more conservative and individualized approach in recommending screening for her patients.