New mammogram guidelines frustrate doctors, cancer survivors

Dianne Martinez spent two weeks last month fretting over abnormal mammogram results.

Breast cancer and its painful consequences were constantly on her mind as she underwent additional tests that eventually ruled her disease-free. But the time and anguish she endured were a small price to pay, the Tampa nurse said.

"I kept thinking positive, that they're just checking to make sure it's all OK," said Martinez, 59. "The benefit … outweighs all the anxiety."

Martinez's perspective flies in the face of the U.S. Preventative Services Task Force's new recommendation that women 40 to 49 and 75 and older no longer get annual mammograms. The risk of a misdiagnosis and potential overtreatment, and the associated stress, outweighs the benefits of regular exams, said the panel of doctors and scientists charged with assessing the value of various medical practices for the general public.

This recommendation, one of many made regarding cancer screening practices, is being met with outrage and frustration from doctors and breast cancer survivors who advocate early detection. Tampa gynecologist Jill Hechtman said she relies on mammogram guidelines from the American College of Obstetrics and Gynecology. That organization, like the American Cancer Society, recommends annual mammograms for all women 40 and older.

"I recommend today the same thing I recommended three days ago," said Hechtman, who called the task force recommendations "a travesty."

Joan McCarthy, a physician with South Tampa Gynecology, said she regularly sees abnormal mammogram results, or "false positives," that require more tests before official diagnosis. The additional tests and the anxiety they create are logistical and emotional burdens, but they are important to the women who end up diagnosed with cancer, she said.

"This makes you realize not everybody is the same," McCarthy said. "Medicine is not one size fits all."

Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the United States this year. The task force acknowledges that mammograms can find cancer early and have been responsible in part for the decrease in breast cancer deaths. Since 1990, breast cancer mortality rates have been decreasing on average 2.3 percent a year.

Michelle McDonough, a radiologist at the Mayo Clinic in Jacksonville, said the report ignores that idea that screening aims to avoid every potential cancer death.

"I'm always surprised by anything that suggests you wait to diagnosis a cancer," she said.

However, the new guidelines address the concern that mammograms may not be the best solution for the population as a whole. For example, starting annual mammograms at age 40 prevents one additional death but also lead to 470 false alarms for every 1,000 women screened. Continuing mammograms through age 79 prevents three additional deaths but raises the number of women treated for breast cancers that would not threaten their lives.

"You save more lives because breast cancer is more common, but you diagnose tumors in women who were destined to die of something else. The over-diagnosis increases in older women," said Georgetown University researcher Dr. Jeanne Mandelblatt.

Concerns about the health risks associated with biopsies and unnecessary treatment is separate from the value of mammograms, said Tracy Halme, a radiologist at the Breast Center at St. Joseph's Women's Hospital. She said the recommendation "puts fear and confusion into years and years of study."

"I do not believe the solution to unnecessary biopsies is to take away screening from an entire group," said Halme, who last month diagnosed four women younger than 40 with breast cancer.

Two years ago, Tampa medical assistant Jacqueline Birthwright needed a biopsy to check on an abnormal mass found during a mammogram. The procedure hurt, but it was necessary, she said.

"Luckily for me, it came back negative; but what about those for whom it doesn't?" asked Birthwright, 47.

Breast self-exams also were discouraged in the report. The task force said there wasn't sufficient evidence that they were being done correctly or leading to successful diagnoses. That baffled Halme, who said self-exams can be effective. "Why wouldn't we encourage something that is free and that could save some lives?" she asked.

Breast cancer in younger women tends to be more aggressive, Halme said. In her opinion, that makes early detection even more critical.

Tampa resident Rachell Moodie was just 24 when she discovered through a mammogram that she had an invasive form of breast cancer. While she doesn't think annual mammograms are a must for women her age, she thinks they are for those in their 40s, like her mother.

"Losing your hair, your breasts, everything you thought was normal is extremely difficult," said Moodie, who underwent a double mastectomy and chemotherapy. "I'd love to just have the anxiety of having a mammogram come back unsure."

Hechtman is particularly worried about women 75 and older not getting screened. She worries that the task force report will give insurance companies an excuse to withhold payments for mammograms. And she blames the media for losing sight of the importance of early diagnosis of cancers.

"There's nothing wrong with over-diagnosis and treatment," Hechtman said. "There's something wrong with missing it."