Breast-cancer doctors in Colorado say they have no plans to change their recommendations based on a government task force’s suggestion that women don’t need mammograms until they are 50 — and then every two years, not annually.
The independent panel, the U.S. Preventive Services Task Force, also recommended against teaching women to do regular self-exams and concluded that there is insufficient evidence to recommend that doctors perform regular physical breast exams.
The findings underscore a decades-long debate in the medical community about the benefits and risks of routine breast-cancer screening for younger women.
The conclusions also plunge the nonpartisan, nonpolitical advisory panel into the middle of a strident Washington discussion about health care, which has included allegations from Republicans that the Democrats’ proposed reforms would lead to reduced care for patients.
“The thing that most disturbs me about this publication is that there is no new information,” said Dr. Anthony Elias, director of breast-cancer research at the University of Colorado Denver’s division of medical oncology. “It’s merely a reinterpretation of what’s going on, then people put together a computer model and decided the cost-effectiveness may not be as good.
“The impetus of this is health care reform and cost-cutting,” he said.
40 studies analyzed
But Dr. Ned Calonge, chairman the 16-member panel, defended the recommendations and denied that cost or the debate over health care reform played any role in the new guidelines.
“Cost just isn’t a consideration when the task force deliberates,” said Calonge, who also is chief medical officer at the Colorado Department of Public Health and Environment.
To conduct the review, Heidi Nelson of Oregon Health & Science University in Portland led an analysis of data from more than 40 studies, including a new British study involving more than 160,000 women and data collected from more than 600,000 women in the United States.
In addition, the task force commissioned an unusual study led by Jeanne Mandel blatt of the Georgetown Lombardi Comprehensive Cancer Center, funded by the National Cancer Institute, that involved six teams of researchers analyzing the risks and benefits of 20 screening strategies.
“I think any time you use science to kind of fundamentally change what people are used to, I think it’s a difficult thing to grapple with,” Calonge said of the new guidelines.
Both the research and the policy decisions surrounding tests for early breast cancer have had a topsy-turvy history, leading to confusion among patients and caregivers alike.
For example, when a National Institutes of Health panel declared in 1997 that routine mammograms for women in their 40s were not worth the risks, the Senate convened hearings and voted 98-0 to urge the National Cancer Advisory Board to endorse routine screenings for that age group, a recommendation that eventually was adopted.
In addition, the same panel that issued this week’s guidelines came down on the other side of the issue under different membership in 2002. The task force, a 16-member group of independent experts put together by the Department of Health and Human Services, concluded that the evidence at the time tilted slightly in favor of using routine mammograms for women in their 40s.
Like many breast-cancer experts in Colorado, researcher Elias said he believes yearly mammograms are critical for women 40 and older.
Survivor “horrified”
“There is no question that while mammograms are not perfect, they have reduced mortality,” he said.
Kathy Otterbein, 45, has had breast cancer twice. Her first diagnosis came at age 39. She had a 3-inch mass that she couldn’t feel with her fingers but was picked up by a mammogram.
“I’m horrified,” she said of the new recommendations.
Mammograms, she said, “are our survival. If they take the (annual) mammogram away, I don’t know what will happen to that part of the population.”
The immediate impact of the newest guidelines is unclear.
Forty-nine states require insurers to cover screenings for women age 40 and older; Medicare also pays for the procedure. The task force said women with a family history of breast cancer or other risk factors should have routine screenings.
Michele Ostrander, executive director of the Denver office of Susan G. Komen for the Cure, said that the task force is “well-respected, and we don’t want to negate their findings,” but she emphasized that her organization will continue to recommend annual mammograms for women 40 and over.
“We’re not changing our guidelines based on this,” she said.
Dr. Juhi Asad, a breast surgeon at Colorado Surgical Service in Denver, said the new guidelines might actually increase the cost of health care.
“We can identify high-risk patients” with annual mammograms, she said, “which decreases the cost of health care. If women are diagnosed at a later stage, the majority need chemotherapy and more workups.”
Anxiety is not a danger
She will continue to recommend annual mammograms for women 40 and over.
“Everyone I talked to about it says they’re taking it with a grain of salt,” Asad said. “They say, ‘This is one group that is saying this.’ No one I know is changing.”
She also criticizes the decision by the task force that the “danger” of annual screenings for women 40 and over is the worry it causes over false alarms and biopsies that are not needed.
“They’re saying that anxiety is one of the key factors why they are saying this,” she said. “I think that’s a weak call.”
The Washington Post contributed to this report.
Colleen O’Connor: 303-954-1083 or coconnor@denverpost.com
