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Tuesday, October 4, 2011
The Dreaded Phone Call
"My doctor felt something in my beast at my check up. I have to go for a mammogram."
Or this one:
"The mammogram does show a suspicious mass. I have to have a biopsy."
Or even worse:
"The biopsy was positive. It is breast cancer."
I received all three of these calls recently from someone I love very much. It is a shocking and horrible feeling to know that someone you care about is facing something so terrible and potentially life threatening. The only saving grace is that the person I love got her yearly check ups every year. She went for regular mammograms. Without them, this aggressive cancer might have been found too late. Fortunately, the breast cancer was detected early and chances for cure are good.
There has been a lot of confusing messages in the news lately regarding when to have mammograms and how often. It's no wonder since there are a lot of conflicts among experts in the field. In November 2009, the US Preventative Services Task Force (USPSTF) released new guidelines on using mammograms for screening for breast cancer that were radically different from the previous ones.
Their recommendations were that women should have mammogram for screening every 2 years starting at 50 and no mammograms prior to age 50. They recommended that mammograms not be done past the age of 75. They also stated that they didn't have enough evidence to recommend self breast exam or teaching women to do self-exams.
Many of us in the medical field were concerned that these new guideline would not only confuse patients about what to do for early breast cancer detection, but also influence how insurance companies pay for screening. The task force is a group of scientists and doctors and policy makers with the government. They have very strict rules about when a test should be recommended. They take into account the cost of performing a test and how many need to be done to show benefit. They concluded that the potential cost of the mammograms, both the actual cost and the cost of false positive tests, when weighed against the benefits were too much to recommend mammogram before age 50.
However, the American Cancer Society, the American College of Gynecologists, and the American College of Radiology recommend annual mammogram beginning at age 40 and continuing through age 75 or later depending on the wishes and recommendations of the patient's personal physician. All three also recommend self-breast exams and breast exams annually by a physician. My own professional society, the American Academy of Family Physicians, released recommendations in line with the current USPSTF recommendations.
So......what are we to do? Most of my colleagues are continuing to discuss screening mammogram with our patients beginning at age 40. I generally explain that those USPSTF recommendations were made because there was insufficient evidence to recommend otherwise. It doesn't mean that a women in her 40s should not have mammograms or examine her own breasts. It just means that the scientists don't have enough evidence to say that it is beneficial for the overall public health.
What do I do?
I examine my own breasts monthly. I see my physician annually for a breast exam. I get a mammogram. In fact I had my first one this year. I know there are risks in doing mammograms in younger women. There is radiation in a mammogram. There is the possibility of a false positive mammogram which might lead to other unnecessary tests. But, I still believe that early detection is important and that those risks are minimal in light of the fact that detecting breast cancer early is so important.
October is breast health month. I encourage you to talk to your physician about whether a mammogram is right for you and when to begin screening. If someone you love has not had a mammogram, please encourage her to go. And remember.....breast cancer can happen in men also. Don't ignore changes in your breasts whether you are male or female. See your family physician regularly. It really can be the difference between life and death.