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| Questions raised about new recommendations |
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Wednesday, November 18, 2009
By MICKEY POWELL - Bulletin Staff Writer
Women should continue getting yearly mammograms when they reach 40 years of age, despite what the government advises, a local oncologist said.
Dr. Thomas Berry, chairman of the oncology committee at Memorial Hospital in Martinsville, said Tuesday there are “some significant questions as to the validity” of findings by the U.S. Preventative Services Task Force.
Findings of the task force, a government panel of doctors and scientists, can sway whether Medicare and insurance companies pay for patient screenings, The Associated Press reported.
The task force announced Monday that it now is suggesting that women get mammograms every two years starting at age 50, based on its examination of data.
That position conflicts with American Cancer Society guidelines suggesting that women undergo a mammogram every year beginning at 40.
Breast cancer is the most common cancer and the second leading cause of cancer deaths among American women.
Berry said that to his understanding, the task force contains “no surgeons and no oncologists” and is comprised mostly of people in the public health field and statisticians.
“There needs to be some independent review” of its findings, he said.
The task force 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, and
• The value of breast exams by doctors is unknown, and breast self-exams are of no value.
International guidelines also call for screenings to begin at 50, and the World Health Organization (WHO) suggests having a mammogram every two years.
“Most clinicians don’t agree” with the idea of starting mammograms at 50 and think annual mammograms are necessary beginning at 40, Berry said.
He said he has seen many patients between 40 and 49 with breast cancer that was detected as a result of mammograms.
Recent data shows that about 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s, while about 22 percent occurred in women who were diagnosed in their 50s, according to the cancer society.
Once women reach 75, they still can benefit from mammograms, but Berry said that whether to get them — as well as how often — then becomes “an individual decision.”
That is because some women at that age and older have illnesses that could end their lives sooner than cancer might, and those illnesses may need to be treated more urgently than the cancer, he indicated.
In recent years, medical groups such as the cancer society have backed off promoting breast self-exams due to a lack of evidence of their effectiveness.
The WHO states on its Web site, though, that self-exams have empowered women to take responsibility for their health. It recommends self-exams, but mainly for raising awareness among women particularly at risk for developing breast cancer, such as those with a family history of the disease.
“I don’t see any negative side to breast self-exams” for all women, Berry said. “I don’t know why” anyone would recommend against it.
Breast tumors often are “a mass that can be felt” and “an overwhelming majority of those are found by the person,” not a doctor, he said.
And, the sooner cancer is detected and treatment begins, the more likely that the cancer can be cured, he indicated.
The bottom line is that “if you don’t get (find) the cancer, people are going to die,” Berry emphasized.
Robert Stowe, manager of the Martinsville cancer society office, declined to be interviewed. Instead, Domenick Casuccio, the society’s regional director of communications and marketing based in Glen Allen, returned a phone call.
The local office is “not commenting on the story” because the task force’s recommendations are “a national story,” Casuccio said.
He provided a copy of a statement by Dr. Otis Brawley, the cancer society’s chief medical officer. It mentions that the society “continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40.”
The society’s recommendation is based on a review of “virtually all the same data” that the task force reviewed, plus additional data, the statement says. |
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