At Il Monastero at Saint Louis University, breast cancer support group The Breakfast Club held a forum to clear up confusion about new breast cancer screening guidelines on January 11, the same day the U.S. Preventive Task Force released its final breast cancer screening recommendations. Those recommendations are differ from guidelines released two months ago by the American Cancer Society (ACS).
“These recommendations were based on European women, from Sweden and Canada and we weren’t represented in the studies,” said Sherrill Jackson, founder and president of The Breakfast Club.
ACS recommendations are that it is a woman’s choice to mammogram screening at ages 40-44, with annual mammograms from age 45 to 54, with women 55 and older switching to mammograms every two years. The USPSTF recommends women in their 40s weigh the benefit of potential harm vs. good, and starting at age 50 – recommends mammography every two years until age 74.
The new recommendations apply women with no symptoms or heightened risk of breast cancer. This would be women ages 40 and older with no preexisting breast cancer, diagnosed high-risk breast lesion, no known underlying genetic mutations; no first degree relative (mother, sister, child) or second degree relative (grandmothers and aunts) with breast cancer and who do not have a history of chest radiation at a young age.
“It is well established that early detection combined with effective treatment reduces breast cancer mortality,” said Helen Chesnut, executive director of Susan G. Komen Missouri. “Komen believes screening tests, if recommended by a healthcare provider, should be covered by insurers and government programs no matter a woman’s age.”
Advocacy groups and individuals who promote breast cancer screening via mammography are not particularly happy with the new recommendations. After all, it is the only clinical screening available, and breast cancers in minority and poor women are aggressive and show up at younger ages.
“Our concern is that these recommendations don’t take into account the disparities that already exist,” Jackson added. “The other concern is – if this recommendation becomes a policy, insurance policies won’t pay for women to get a mammogram at 45. If anything is going on with the women, it’s going to be diagnosed later.”
Unfortunately, the scientific outcomes do support mammography screening as a tool to reduce breast cancer deaths for women in their 40s, according to the American Cancer Society’s Chief Medical and Scientific Officer, Otis Brawley, MD.
“It’s fair to say we need a useful screening test for women in their 40s; it’s also fair to say that mammography is not a very good test for women in their 40s,” Brawley said. “It’s a much better test for women in their 50s an it’s an even better test for women in their 60s, and part of the reason for that is actual density of the breast.”
While mammography is beneficial to early detection when cancers are more treatable, many women find lumps or breast abnormalities on their own.
“Most women who do well who are diagnosed in their 30s and 40s find their own lump rather than a mammogram finding it,” Brawley said. He added that studies have shown that women screened with mammography have a 20 percent lower death rate, than women without any screening.
“A 20 percent lower death rate from breast cancer – that translates that screening did not help 80 percent of the women who needed it to help them,” Brawley explained.
Not speaking of any specific group or organization, Brawley told The American that advocates for screening have “hijacked” the issue – with billions of dollars going into screening that does not reduce mortality, when those dollars could be better spent developing a better screening tool for younger women.
“The advocacy community, and some people who are doctors who don’t understand screening have hijacked this entire issue and they spend a lot of time lobbying for money to screen women in their 40s with mammography and they spend very little time, if any, lobbying to develop better screening tests,” Brawley said. “You will find that there is some attempt to develop, CT of the breast … ultrasound of the breast; there is some MRI screening of the breast that’s out there, but an organized effort to find something that actually works for younger women – it is not happening.”
New recommendations say women should weigh potential harm vs. good for annual screening or mammography screening at earlier ages. Potential harms include false positive results, radiation exposure, stress and anxiety, unnecessary biopsies, over-diagnosis and overtreatment for a breast cancer that may not become a health threat in a woman’s lifetime.
“These new screening recommendations bring the potential to lead to reduced accessibility to and coverage for health screenings from both private and public insurers,” Chesnut said.
The breast cancer forum was held in conjunction with Saint Louis University and Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine.
Jackson said her group will look into a collaboration that involves pulling together data on African American, Hispanic, Latino, LGTB and medically underserved women.
“The most important thing that women who are concerned about breast cancer and women who are concerned about decreasing breast cancer mortality, especially in Missouri, need to be worried about the women who don’t get screened even though recommendations are that they do get screened,” Brawley said. “And they need to be worried about quality of care, because we have good signals that we have a large proportion of the population that gets less than optimal quality care.”
He said Missouri is one of 14 states with worse breast cancer outcomes.
“In Missouri, we have data that show that one-third of women, whether they are white or black who are supposed to get radiation therapy after a lumpectomy for breast cancer do not complete the entire course of radiation therapy,” Brawley said. “There is a goodly number of women who are prescribed chemotherapy, either oral or IV who do not take it.
“How do you know when the doctor is not doing you a good service? The best way to do that is to actually get a second opinion on almost every major decision in your breast cancer care.”
Read the American Cancer Society recommendations at www.cancer.org.
Read the final USPSTF breast cancer screening recommendations summary at http://tinyurl.com/h6pnh58.
