As a practicing gynecologist, I was surprised by the latest recommendations concerning mammograms. The committee that made these recommendations has stated that routine mammograms don’t need to start until age 50. They then should be every other year. They also stated that physicians should stop teaching their patients self breast exams (SBE).
The latest round of mammogram recommendations came out of a committee that was looking at cost effectiveness of preventative medicine testing. There was no discussion with the medical community that does the testing or treats the women who have breast cancer. The people on this committee are not even all physicians. They are all basically researchers. They deal with the economics of health care, not patient care. The physicians on this committee are NOT breast surgeons, oncologists or mammographers. This committee is set up to make recommendations for cost cutting prior to passage of the health care bill that is currently in Congress. If these recommendations are in effect when the bill passes, this will affect payment by government programs like Medicare and Medicaid.
Breast cancer is the most frequently diagnosed cancer in women in the United States. It is the second leading cause of cancer death in women (behind lung) in the US. As with any cancer, the earlier the diagnosis, the more likely the woman is to be cured. Earlier tumors can be treated with less aggressive surgery. A small tumor may be treated with a lumpectomy versus a complete mastectomy.
Colleagues tell me that they are seeing more breast cancer in women in their 40s. Some general surgeons say that the average age of their breast cancer patients is in the 40s. The radiologists that read mammograms tell me that they are seeing more cancers in women under 50. Early tumors tend to be more aggressive. Are we to wait until age 50 or until the cancer needs radical treatment?
Many women actually find their own breast cancers when they do self breast exams. Body awareness is important because a woman is more likely to notice a change if she has examined herself on a regular basis. The combination of self examination, clinical breast exams and mammograms has been proven over the years to be effective in diagnosing asymptomatic breast cancer.
Medicine is part science, and part art. The current screening and treatment of breast cancer has evolved over the years. It may be time to look at it again. However, I think that it should be looked at by the doctors who deal with the disease, not by some researchers who are trying to “cut costs” without looking at the human toll of the disease that we will be seeing when the screening tests are cut. This is, in my opinion, a way of introducing rationing into the system through the back door.
Mammograms may not be the most perfect screening test that we have. There does not appear to be a better test at this time. Dying of cancer or delayed diagnosis because the government does not want to pay for the test is not, in my opinion, an option. In a recent poll on a doctor’s web site, 90% of the physicians who answered the question stated that they would not adopt the new recommendations. I agree with them.