I wrote about this a couple of weeks ago when it became clear the American Cancer Society was mulling over whether screening recommendations should be changed for breast and prostate cancers.
The concern, of course is, are some indolent, non-aggressive cancers suspected or discovered and patients are harmed with invasive tests and/or unnecessary or premature treatment – costing billions of dollars in precious healthcare dollars, causing more harm than good, and not statistically saving lives?
Now comes today’s news that is sparking a lot of debate and controversy among doctors, patients, and biostatisticians. The United States Preventive Services Task Force, an influential group that advises government policy makers, insurance companies and doctors says standard screening mammograms should start at age 50, not 40 (except in women at high risk for breast cancer), and should be performed every two years, not annually. Also, they say older women (over age 75) don’t need the screening and all women do not need to do breast self exams.
Wow! This flies against decades of telling us “early detection saves lives.” But the statisticians say when it comes to all the breast cancer screening we’ve done, we aren’t saving lives, just spending money needlessly, causing anxiety among women, and sometimes causing needless pain and harm.
Many, but not all, doctors are howling in protest – even if in Europe they follow the guidelines that have been suggested here. Is it because they want money from screening more people? Or is it because they have seen mammograms spot real cancers among women in their 40’s that would have been missed, or even that they have had patients who found a cancerous lump from a self exam that led to life saving treatment? I have heard stories just like that.
It is hard to tell a woman you are just a part of a big statistic. And that statistically mass screening starting at 40 and continuing every year isn’t worth it. For the woman who worries she will be the one cancer picked up from such screening this is definitely a hard pill to swallow!
I saw Dr. Susan Love, the famous UCLA breast surgeon, on the news last night saying she favored the change and thought it should have been that way all along. Fran Visco, who leads the National Breast Cancer Coalition agrees. But some experts who I respect, like Dr. Connie Lehman, Director of Breast Imaging at the Seattle Cancer Care Alliance, do not. We’ve just posted her comments recorded Sunday as we saw this news coming.
I am on the fence. Do we know better than Europe? Or are we just recoiling from changing course after decades of promoting early screening?
What do you think?
No matter what, please see our programs on screening for women at higher risk for breast cancer, those with the identified genes and/or family history. No one is saying they shouldn’t be checked regularly and early.
Wishing you and your family the best of health!
Andrew