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November 22, 2009

Our View — Women need to talk to doctors about screening

Lots of women right now are understandably confused about when they should get mammograms, a breast cancer screening tool that has been lauded to have saved lives.

A federal task force last week recommended women wait until age 50, rather than the well-established baseline age of 40, to get their first mammogram. It also said to get them every two years instead of annually. The drastic changes in thinking have caused an uproar from everyone from the American Cancer Society to politicians who claim this “rationing” is the sign of things to come if government becomes more involved with health care.

Obviously, cooler heads need to prevail.

What we know now is that the U.S. government insurance programs will continue to cover mammograms for women starting at age 40. Kathleen Sebelius, U.S. secretary of health and human services, stressed that the task force that made the recommendations does not set federal policy or determine what services will be covered by the federal government.

Women who have survived breast cancer because of screenings in their 40s are speaking out about the need to retain current practices. Many health providers, including locally and at the Mayo Clinic in Rochester, do not support the new guidelines. Dr. Mark Myers, chief of mammography at Mankato Clinic, said about one-fourth of all breast cancers are diagnosed in women age 40-49. Many health experts are stressing the need for women to talk to their doctors to decide what is best for their individual situation. (That conversation should also include discussion about the risks of mammograms, including false positive readings and unneeded biopsies.) The decision should be based on the balance of a woman’s history, risk factors and level of concern.

Skepticism of the new recommendations is warranted. Many doctors say lives are saved because of current breast cancer-screening practices, including self-exams, which the federal panel also dismissed as ineffective.

The breast cancer death rate has dropped 30 percent since 1990 because of the advent of mammography, Mankato Clinic’s Myers said.

Although criticism is warranted, the panel’s work shouldn’t be dismissed outright. Evidence-based medicine should be taken seriously. But one study also shouldn’t be allowed to negate the progress made in breast cancer treatment.

The panel recommendations should be examined and analyzed and be put in proper perspective by other medical experts. The mammogram issue isn’t going to be figured out in a week, and it shouldn’t be.

In the meantime, women should talk with their doctors about how to proceed in the way that is best for them.

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