This sounds really scary:

http://www.cnn.com/2009/HEALTH/11/16/mam...index.html

This is only a "recommendation" at this point, but I'd say the fear of insurance coverage dropping on mammos is a valid concern.

And don't you just love how a group comprised of exactly ZERO oncologists is making recommendations on cancer prevention?

I'd bet the farm that this is solely brought about by the insurance companies to save money. This will put women's lives at risk over profit. We need health care reform yesterday!

Funding for the research behind these new guidelines came from the Agency for Healthcare Research and Quality -- IOW, your tax dollars at work. For some information on them, look here: http://www.ahrq.gov/about/ataglance.htm

Health insurance providers do use their information as do the policy makers for government healthcare systems.

The physician who headed up this particular task force, Dr. Diana Petitti not only isn't an oncologist,she's not a clinical physician at all. She is professor of medical informatics -- an epidemiologist. More on her here http://sci.asu.edu/directory/page.php?profile=794

In Canada and the UK, according to About.com, routine mammos start at age 50.

Out of curiosity, I went looking for recommendations in France (I read French, but found the information in English). The French government will pay for mammos for women between the ages of 50 and 60 -- every 3 years. French physicians, however, believe that mammos should start at age 40 and be done every 2 years (more often for high risk women).

I'm sure this is about cost-effectiveness rather than radiation risk, because newer mammo machines use tiny doses of radiation. MD Anderson has already announced that they disagree and will not be changing their protocols. The American Cancer society agrees with MD Anderson.

Dr Love was involved in this study, and Dr Love has done a lot of research in the field of breast cancer. It still has me making the face. Especially the recommendation for women not to do self exams.

I'm excited to talk to my doctors today to get their take on this matter.

I was supposed to get my baseline at 30, according to my mom's breast surgeon. Instead I needed a diagnostic mammo at 29, and have been going to a breast surgeon ever since (well, I'm overdue right now, but do as I say not as I do ). I guess I'll be able to get around whatever guidelines they have because I am at a higher rsk than most.

Recently in the world of radiology, we were able to get all women with dense breasts to have ultrasounds, and women at a high percentage of risk for breast cancer to get MRIs (and ins. companies to pay for these). It seems to me that if they're going to pay for more tests on some women, they will pay for fewer tests for other women, in order to balance it out. That's my guess, anyway.

But Dr. Love?

Margaret, you have a family history, so the guidelines don't apply to you.

Stats are stats, no matter what kind of doctor you are. If mammograms for younger women prevents so few deaths and creates so many problems with false positives (plus exposing breast tissue to radiation so often), it makes sense to stop recommending them for everyone, and stop relying on them - which might spur the effort to find a better diagnostic tool for women younger than 50.

I'm curious what the cost of ultrasound is vs mammo.
Whenever I had something questionable on a mammo, the first step was ultrasound. That might be a more effective diagnostic - I'm guessing the cost is higher.

This study disturbed me - especially because the Breast Cancer Society people are so opposed. I do get the statistics on the mammos, but I'm not sure how self and Dr breast exams can be a bad thing.

(11-17-2009 10:57 AM)theworm Wrote:  This study disturbed me - especially because the Breast Cancer Society people are so opposed.

Not all cancer organizations are against the new guidelines

Quote:Other advocacy groups, like the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network, welcomed the new guidelines.

Somewhere we'll find the happy medium between too much testing too soon and not enough. Either way some women will always fall through the cracks and it will cost them their lives.

I would hate to see insurance companies not pay, mammos are expensive even with insurance.

I think the real solution will be better testing technologies. Right now they can't differentiate between cancers that are slow-growing and not life-threatening vs. cancers that are not.

However, we don't have that technology yet and so I think we should use what we do have.

Even though the numbers show it's largely ineffective and largely causing more harm than good?

I haven't seen the numbers that show routine mammograms before 50 cause more harm than good. Personally, I'd rather worry about a false positive and go for more testing, than live cheerfully with undiagnosed breastcancer.

The study was not focusing on the (low) dose of radiation given by mammography, it was focusing on "anxiety" and "false positive" results. I will more than gladly face those "risks" when the other option is breast cancer that goes undetected.

Basically, the study is saying that of women 40-49, only 2 per 1000 will die for lack of screening. I already know many women in that age group who have been diagnosed. I sit next to someone who had stage 3 cancer this year at age 48, and she had been negligent on having her mammograms. I hate thinking that people I know would be at risk because the numbers weren't statistically significant enough to the doctors involved in this study.

When I asked my radiologist about this today, we had a lengthy discussion. His one line sentence, to sum it up, was basically "this is going to cost women their lives."

Worm, Ultrasound alone doesn't cut it. If you are having ultrasounds they are looking at masses. They could be cystic or solid, and that is what the ultrasound tells them. Cysts are generally "fine." Solid will generally need to be biopsied.

There's another form of breast cancer, which happens in the ducts. This is best viewed on mammogram. These are the "calcifications" that women sometimes have (although most calcifications are benign). Calcifications do not show up on ultrasound. They can show up even if you never had them before, and they can change over time, which is why they are followed.

Breast MRIs can be helpful too, but no one test alone is "the" test.

This is a very interesting discussion to me, but, I worry that women will get the wrong message from this study. One part of the study suggests that we stop teaching women how to do breast self exams. However, they mean to stop formally teaching women, but they don't mean that women shouldn't be familiar with, and checking, their breasts. How confusing is that? I'm certain that women are getting the wrong information.

Here's the American College of Radiology's stance on the issue. I urge you to read it:
http://www.acr.org/HomePageCategories/Ne...oRecs.aspx

Thanks for the info, Margaret.

I think we all have stories with positive and negative endings about women with abnormal mammograms. I can accept that perhaps the cost of mammograms yearly at certain age groups for woman not "at-risk" is high, and that perhaps the recommendations should be changed. I was actually more stunned by the statement that self-exams and doctor exams aren't useful. Honestly, I don't do regular self exams because everything feels lumpy to me - and when I did have a lump biopsied, I just couldn't feel the thing - even with the my gyn and the surgeons help. The doctors felt it though. Thankfully it was benign. Perhaps the cost of all the subsequent tests was high but it ruled out a problem. I remember that the mass was so small the doctor debated biopsying it, then did. Had he opted not to biopsy, I think I would have had to rely on the mammogram to ensure that the mass wasn't growing. In that case, there would have been a medical reason for the mammogram. Saying that the physical exam has no (or little value) though would have meant that I might not have gotten a mammo at all for another 10 years.

I'm all for cutting costs, and I understand that there are cost/benefit ratios, but it seems that the recommendation for women without a family history or other high risks is to do nothing before 50. I just can't really wrap my brain around that. I do think the answer is probably some other diagnostic tool, but it doesn't seem that we have one yet.

NPR interviewed one of the drs on the committee tonight who made it clear it wasn't a cash issue, it was about the additional tests that women needlessly go through, the time and physical toll and anxiety involved. She also said the recommendations are when to start "automatic" screening, but that every woman needs to talk to her doctor about her particular circumstance. African-American women, for example, get breast cancer at lower rates than white women but their cancer tends to hit earlier and be more lethal. As for breast self-exams, there were no differences in outcomes between women who were taught by their doctor how to do self-exams and did them regularly and women who weren't taught and didn't.

Regarding "I know a woman who..." stories. I knew a woman who had something detected before age 50 and it turned out to be nothing, but it took six months to get to that point. I knew a woman 60+ who ignored something and died. But the plural of "anecdotes" is not "data."

I don't believe that any of us are "experts" in this field. I believe that all of us can find relevant and solid "data" to support our personal beliefs on this or any other topic/issue. I believe that I will continue to have mammograms on a yearly basis even though it does not run in my family. Women's issues are always the ones to have less funding....for that matter, why don't they cut the PSA tests as well as the mammograms? My husband has one every 6 months because they've been monitoring his prostate for 10 years now. He has the side effects of high anxiety and discomfort of certain exams too. If they decided to recommend and not fund his tests....even though cancer has not been found to be the issue....I would want him to continue too. Anxiety is a poor example of a side effect.

I am following this closely locally, and no MD I've spoke with has supported this. Reading the papers this morning further proves to me that locally no one is on board with this task force's recommendations. Furthermore, Dr Diana Pettitti, the vice chair of the government panel, is not an MD. She's a PhD. I'll trust my local MDs, who see this disease day in and day out, much more than some researcher.

I am sure that the tides will turn on these recommendations. Right now all it's doing is confusing women (or angering women). Eventually it will just go away.

So, I'm the only one glad to have another decade with no boob-squishing?

It's not that you're the only glad one - I would be very happy not to be squished - I just want to understand the issue.

And so help me I know I'm immature, but I can't stop giggling that the Dr.'s name is P-Tittie

I'm wrong above. Dr. Pettitti is an MD. And Dr Love is not on the panel. I will have to investigate what her link is to the study later, but I did want to correct the information I stated above.

BTW... her name is pronounced like Pit-ee-tee, I believe I went to school with someone with that last name

(11-18-2009 08:51 PM)theworm Wrote:  It's not that you're the only glad one - I would be very happy not to be squished - I just want to understand the issue.

And so help me I know I'm immature, but I can't stop giggling that the Dr.'s name is P-Tittie

You are NOT immature....that IS funny! (or maybe I've been hanging around with junior high kids too long

I've often noticed direct relationships between names and occupations. I had a proctologist named Dr. Tootla....I saw a billboard for an internist named Dr. Atchoo....and more that escape me at the moment. Too funny stuff!

My mom worked for Dr. Blood.

When I was younger, I had to change doctors because I couldn't deal with a GYN named Dr. Ram.

(11-18-2009 07:58 PM)eris esoteric Wrote:  So, I'm the only one glad to have another decade with no boob-squishing?

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Well, I for one am kind of looking forward to it - with no medical history (I keep meaning to write off and ask for it, but my brain this last year can't hold on to a thought any more than a sieve can hold on to water....) I don't know what my chances are of developing something, and I look forward to getting a good picture of the situation.

Luckily, I just turned 38, so even if the wheels of industry do decide to cut down on paying for mammos, hopefully it will be after I've already started down the road of routine squishes and won't have to worry about them making me wait.

Baselines on most medical issues are very important.

MJ Wrote:But the plural of "anecdotes" is not "data."

:clap:

And now (money not being the issue of course) they are changing guidelines on pap smears as well. Don't need them once a year anymore....Less of them costing less of course.

---

(11-20-2009 10:06 AM)hadassahchana Wrote:  

MJ Wrote:But the plural of "anecdotes" is not "data."

:clap:

And neither is "data" always reliable.

But OB/Gyn physicians have long suggested that Pap smears don't need to be done quite so often for MOST women. Since the development of the HPV test to go along with the Pap, it's easier to tell who is high risk.

Emphasis on the most. Women who have had any anomalous pap smears wouldn't be included in this group and neither would women who have multiple sex partners (or whose partners have multiple partners). Women whose moms used DES during pregnancy -- etc. Consult your doc for more info. If your doc is one of those who believes in doing them every year, regardless, you should probably go along.

The HUGE difference between this recommendation and the mammo recommendation is that this one is coming from ACOG -- the people who will LOSE money by going with the recommendation. When someone wants to cut their own income, I'm less inclined to be suspicious of their motives.

I don't know. I never had multiple partners. I was married. I was 36 and had pre-cancerous cells that they got rid of. Without the yearly pap, maybe they would have grown into a dangerous situation. Yes, it's antecdotal but each person that it happens too is both antecdotal and a statistic.

But, lately, I just don't know what is the right or the wrong thing to do. Don't know if I'm just confused or if I'm being successfully endoctrinated into believeing what I'm supposed to believe. Tonight, I'm too tired to even care.

I'm with you, Sandy. I don't want un-necessary tests, but I don't want to get sick from something that could have been avoided with a test.

Sandy,
Pre-cancerous and maybe they would have grown into something dangerous, or maybe they would have just resolved by themselves. It happens. I'm glad they were able to fix the problem and I understand your concern about the new recommendation.

OTOH, more anecdotal evidence, if I hadn't had my colonoscopy at age 46, I'd be dead. Recommendation for people with no family history is 50. I did have VERY minor symptoms, but I had to argue with the doc to get a referral for a colonoscopy. She still uses that experience to badger 50 year old patients into getting that first colonoscopy.

(11-20-2009 10:06 AM)hadassahchana Wrote:  

MJ Wrote:But the plural of "anecdotes" is not "data."

:clap:

I had heard the original quote is actually "the plural of anecdote is data." The reasoning being that anecdotes are data, data is noted and forms hypothesis, more data is collected and the hypothesis is proven or disproved.