Video: New mammogram guidelines: What should women do?

By Chief medical editor
NBC News
updated 11/17/2009 5:19:23 PM ET 2009-11-17T22:19:23

For the last 20 years, I — along with most other medical experts — have been saying the same thing over and over about screening for breast cancer: early detection saves lives.

That advice has been turned upside down with the new recommendation issued by a government advisory panel. The U.S. Preventive Services Task Force says that most women don't need to get a mammogram until age 50, unless they have a known risk factor.

This major reversal in breast cancer screening advice is causing a lot of confusion and anger among women who doubt the motivation and timing of the decision.

Read on for answers to your questions about the new mammogram guidelines.

What are the real risks from starting to have a mammogram at age 40?
— Anonymous

A woman in her 40s has denser breasts, which means mammography will miss some cancers because it can’t see them. Or it will see normal lumps and bumps and misread them as cancers, which can lead to further testing, sometimes biopsies, more anxiety and money not prudently spent.

Mammograms are not freebies. Every time you go in for a mammogram, you get radiated and there is a cumulative effect. We’re exposing women to radiation for no real benefit for 10 years.

Personal anecdotes matter, of course, but this was really looking at the hard numbers. In order to save one woman’s life in her 40s, you have to screen 1,900 women. You could conversely say you’re unnecessarily radiating 1,900 women to save one life. If you are that one life, you might say it’s worth it. If you’re one of the 1,900 women who don’t need the X-ray, you’ll say it doesn’t make any sense.

We know that X-rays over a long period of time damage cells and are their own risk factor for cancer, including breast cancer. That’s the concern here.

We have no problem telling people to get prostate screening at 50, or to get colonoscopies starting at 50. Now, we’re just saying mammography at age 50.

The scientists have been looking at this for a long time. This is not President Obama screwing with your health care. This is not the insurance lobby trying to take health care away from people. This advice is transparent scientists making recommendations based on data.

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Would you recommend against having a mammogram for a 40-year-old lady with no known risk factors who asks you for one?
— Aiman, Meadville, Pa. Video: Controversy over breast cancer screening

Yes. I happen to believe that these numbers are for real. I am looking at it through the lens of my daughters. I have a 23-year-old daughter. Based on these recommendations, would I urge her to go in at 40 with no family history and no other risk factors? No.

I respectfully have changed my viewed based on the latest evidence.

I take a lot of the responsibility and a lot of the blame for being a medical correspondent and preaching early detection. The only problem was, we didn’t ask the big question: does finding tumors equate to saving lives in that 40-49 year-old age group? The answer is no.

I have learned as much from this as everybody else. But I respect the people who did the research. As painful as this is, we should applaud the transparency of science as it evolves and the fact that we have people trying to figure out the best answers for us.

The whole idea that younger women shouldn’t be screened because they’ll just be unduly anxious strikes me as rather patronizing. Why is “worry” such a concern and a reason to deny care? I know plenty of women who died of breast cancer but none who died from worrying.
— Anonymous

All the talk of "worry" may sound patronizing. Although most of us don’t fret about our mammograms, there are women who are frozen with fear every time it comes up. We can’t negate the fact that fear occurs.

And it’s not about denying care, it’s about seeing who needs the screening and who the screening serves best? How do we protect people from unneeded radiation and yet get the women at risk in to see the doctor. If you’re 40 and have a strong family history or other risk factors, no one is going to say don’t get screened. We’re just saying, "Oh, I‘ve turned 40 and need to go in for my mammogram" is no longer the smart way to approach this.

I will be 45 in two months, never had mammogram, but it does run on one side of my family. What would the recommendation be? Wait until 50 still or have at least a first one to see where I stand?
— A.L., Brooklyn, N.Y.

This is where you sit down and have a conversation with your physician. What kind of family history? What kind of tumors? At what age? First-degree relatives? History of prostate cancer, colon cancer?

When you have the question of family history, that’s when you individualize. That may be the greatest gift of these new parameters. What they’re are saying is, don’t spray everybody. But the people who really warrant screening, absolutely they should get it.

How can breast self-exams be a bad idea? Why in the world would the government discourage women from doing them? It’s free and many women detect their cancer this way.
— Anonymous

The yield of breast self examinations is actually quite low.No one is saying don’t do it. All the experts are saying is, it turns a woman into thinking her breast are a battle zone. It’s the monthly search and detect and most women don’t do it really well anyway.

Isn't discouraging self-exams all about insurance? How can you say it's not about the cost?
— Liz, Ridgeway, S.C.

This isn’t about insurance. Even with recommendations, insurance policies will not change overnight. Everyone will very carefully look at these recommendations and individualize.  The insurance industry was not part of this task force. These are just scientists.

It does raise an interesting question. What do we spend our money on and is this a form of rationing? These recommendations may be a form of rationing in a good sense. Just as you ration how much you eat at breakfast, lunch and dinner. You have to ration how you access the health care system. Not to be denied health care, but to spend your health care dollars prudently. Perhaps the money you save in your 40s can be invested into finding better screening tools than mammography or better cures for women who have been diagnosed. It’s to make things better, not as a way to turn women away at the door.

How about approving MRIs which do not expose us to radiation, but are quite expensive and hard to get approved by insurance companies.
Esther, Lincolnwood, Ill.

Video: Breast cancer test at 50, not 40, study says

In the 40-49 age group, they looked at digital mammography, ultrasound and MRI. It’s the same conclusion. Younger women have dense breast and they are hard to do imaging in no matter what.

It really is a message to women that — while we have politicized breast cancer and we have an awareness of breast cancer and all of that is good — we have scared ourselves into a corner.

Perhaps it’s OK for most women with no risk factors to take a collective breath. I don’t mean that in a patronizing sense. It’s just that we all feel the pressure of what we think is going to befall us.

Heart disease is a still bigger issue and we are not as militant about heart disease as we are about breast cancer.


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