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Many area doctors still urge mammograms for women in their 40s

This article first appeared in the St. Louis Beacon, Nov. 18, 2009 - Despite new federal recommendations, all women 40 through 74 should continue to have annual mammograms, according to St. Louis cancer doctors. The local medical community has joined the American Cancer Society and other prominent health organizations in rejecting guidelines released Monday by the U.S. Preventative Services Task Force (USPSTF).

The task force concluded that women should wait until they are 50 to have regular mammograms, and then, only once every two years. But doctors at Siteman Cancer Center, the Midwest Breast Care Center, Saint Louis University Hospital Cancer Center and other local medical establishments will continue to recommend annual screenings for women 40 and over. Even so, the new recommendations are worth considering, according to Suzanne Mahon, a doctor of nursing and SLU breast cancer specialist.

“I think doctors need to stop and look at the data, and no one’s had time to do that yet. None of us saw this coming,” Mahon said.

What The New Guidelines Say

The task force found that 1,904 women in their 40s had to be screened to prevent one cancer death but only 1,339 women ages 50 to 59 had to undergo the procedure to produce the same result. One life is saved for every 377 women in their 60s who are screened. The task force report, based on these and other findings from previous mammogram studies, boils down to a few recommendations:

  • Women younger than 50 with an average risk of breast cancer do not need mammograms.
  • All women 50 to 74 should have a mammogram every two years.
  • Breast self exam is unnecessary. (The American Cancer Society agrees that self exams are optional but still publishes how-to instructions for the practice.)

Women in their 40s have more false-positive results and undergo more biopsies that reveal benign tissue. Unnecessary biopsies cause anxiety, according to USPSTF researchers. They also escalate medical costs. Mahon understands that money is a consideration in health care -- especially now. Increasing the screening age recommendation produces a better cost-benefit ratio.
The new guidelines are only for women of average risk, not for those with elevated risk factors such as a significant family history of breast cancer. That makes it even more important for every woman to talk with her doctor to determine if she’s more likely to be a candidate.

“Women need to know what their risk is,” Mahon said.

‘Poster Child’ For Screening In Her 40s

The National Cancer Institute, also an agency of the federal government, is keeping its recommendation that women 40 through 49 should get mammograms every year or two. But the NCI is re-evaluating its guidelines, based on the USPSTF report.

That local doctors are following the American Cancer Society's lead in continuing screenings for all women 40 to 74 makes sense to Helen Chesnut of St. Louis, who was 44 when a routine annual screening caught her stage II breast cancer. Following a lumpectomy and radiation, Chesnut, who calls herself the “poster child for early detection,” is cancer-free.

“It definitely saved my life,” Chesnut said.

Four years later, as a cancer survivor and now the executive director of the St. Louis affiliate of Susan G. Komen for the Cure, Chesnut is a firm believer in annual mammograms beginning at 40. “Mammogram is our best defense, and right now it’s the only tool we have,” Chesnut said.

Jill Conway was 47 when her breast cancer was found through her annual mammogram seven years ago. As a Siteman nurse, she’s well aware of the importance of cost-effective health care and the value of research findings such as those of the federal task force.

“Studies are a good thing, but if you ask those women who’ve been saved -- like me -- those numbers don’t mean a thing,” Conway said.

Negative Side Effects?

Siteman will continue offering free mammograms to under-insured and uninsured women 40 and over through grants from Komen and other organizations. But the new guidelines cut into the consistency of the message, something that worries Siteman radiologist Dr. Kate Appleton.

“There are now conflicting guidelines and that leaves women and their doctors in a little bit of a lurch,” Appleton said.

Women who are unsure which recommendations to follow should talk to their doctor, Appleton said. But the new USPSTF guidelines have sparked another fear: Will they threaten coverage for mammograms for women under 50?

“The USPSTF is a powerful organization, a branch of the government. In the past, their guidelines have had an impact on reimbursement so there is a concern they could potentially alter Medicare and insurance reimbursement for mammography,” Appleton said.

Less coverage would likely result in fewer women getting mammograms in their 40s. That, according to Dr. Paula Georgeof the Midwest Breast Care Center, would be tragic.

“If you wait until you’re 50 to be screened, we’re going to pick up more cancers in a later stage,” George said. “And the bigger the cancer, the worse it may be.”

Nancy Fowler Larson is a freelance writer.