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Mammogram Controversy

As if we didn’t have enough health concerns to worry about, with H1N1 flu in our midst, health insurance reform bills in the Senate, and the specter of no insurance as a consequence of the recession.

Now mammograms.

The new recommendations from the US Preventive Services Task Force, a government-appointed group of national experts, recently advised the Department of Health and Human Services that unless a woman is at unusual risk for developing breast cancer, she could begin getting mammograms after age 50, rather than starting at the previous age 40. Moreover, annual mammograms were no longer necessary. Every other year was fine.

This recommendation was actually made two years ago by the American College of Physicians (internal medicine specialists) and the National Breast Cancer Coalition (a patient advocacy group). However, it’s at odds with the American Cancer Society, other physician groups, and Kathleen Sebelius, newly appointed head of the Department of Health and Human Services. They all believe the current recommendations should not be changed.

The main reasons for the changes are straightforward:
Although women between 40 and 50 do develop breast cancer, during this decade the condition is uncommon enough that the entire population does not need annual screening.
Currently, there are too many false-positive test results–especially in 40-to-50 age group–with women undergoing unnecessary surgical procedures or receiving treatment for cancers that don’t exist.

With more than 200,000 new cases of breast cancer diagnosed every year, women have every right to be concerned about this controversial recommendation. I’ve received emails from patients wondering if the new guidelines reflect a first step in government cost-cutting or collusion with insurance companies to trim benefits and increase profits.

Right up front, let me say neither is the case. Insurance companies are mandated by law to cover annual screening mammograms regardless of a woman’s age. Nothing’s going to change this.

On the other hand, many women have been concerned about the possibility of increasing their breast cancer risk by having annual mammograms. In fact mammograms are performed with very low-intensity radiation and no study has ever shown increased risk from mammograms, even among women with high genetic susceptibility (those who have the BRCA 1 and BRCA 2 genetic mutation) and/or very strong family histories of breast cancer. Early chest x-rays (before age 30) do slightly increase breast cancer risk, but only among BRCA patients.

Most doctors, including me, are happy with the new recommendations. Although we feel mammograms remain the gold standard for diagnosing breast cancer, among women of normal risk every other year is fine.

Here’s what I recommend:
No matter how young you are, if you feel you need a mammogram, either because of something you felt during breast self-examination or simple anxiety, get a screening mammogram.
If you come from a family where a lot of women developed breast cancer or ovarian cancer, you should be followed at one of the comprehensive breast cancer centers and tested for BRCA genetic susceptibility. In the Chicago area, I recommend the one at Rush University Medical Center.
Before age 50, you can rely on a combination of preventive measures (healthy diet with cruciferous veggies, soy, breast self-exams, limited alcohol, no tobacco, adequate vitamin D, selenium, and green tea as a beverage or supplement). For a good combination supplement, created by a breast specialist, click here. For screening, consider a thermogram, which exposes you to no radiation at all.
After age 50, continue your healthy lifestyle and begin every-other-year screening mammograms. You’ll still have an annual “by hand” breast exam at the time of your Pap smear. In the years between mammograms, you can get a thermogram if you like.

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