Mammography can save lives by following ACS guidelines
November 24, 2009
The recent recommendation issued by the U.S. Preventive Services Task Force to revise screening mammography guidelines has generated considerable confusion and worry among women and their loved ones, says Carl D’Orsi, MD, FACR, director of the Emory Breast Imaging Center.
Carl D'Orsi, MD
D’Orsi says he is counseling women who are concerned about mammograms and deciding what screening schedule to follow that they should use the long-established American Cancer Society guidelines: annual screening using mammography and clinical breast examination for all women beginning at age 40.
The recent recommendations by the task force advise against regular mammography screening for women between ages 40 and 49. It suggests that mammograms should be provided every other year (rather than yearly) for women between ages 50 and 74, and then breast cancer screening in women over 74 should be discontinued.
Mammography is not a perfect test, but it has unquestionably been shown to save lives, says D’Orsi, professor of radiology and of hematology and oncology in the Emory’s School of Medicine, and program director for oncologic imaging at Winship Cancer Institute of Emory. Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.
Winship Cancer Institute of Emory University
These new recommendations – which are based on a review that did not include experts in breast cancer detection and diagnosis – ignore valid scientific data and place a great many women at risk, continues D’Orsi.
Ignoring direct scientific evidence from large clinical trials, notes D’Orsi, the task force based its recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50.
The task force commissioned their own modeling study and made recommendations in reliance on this study before the study had ever been published, made public or held to critical peer review, and did not use both randomized, controlled trials and already-existing modeling studies, explains D’Orsi.
If Medicare and private insurers adopt these flawed recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women, says D’Orsi.
The recommendation made by the US Preventive Services Task Force affects asymptomatic screening only. Women with symptoms would be able to have mammograms at the expense of their insurers. Those who intuit problems would have them reimbursed if indeed a problem is identified. The problem is that despite living in a digital society, we do not have a national data bank providing real numbers that support the efficacy of annual mammograms performed on women in the 40-50 age range.
Thanks for you comments, Carolyn. The national dialog on this issue continues.
I am desperate to have a mammograph I currently have no insurance and every place I have called has run out of funding for free or low cost mammographs. I have a mole under my left breast and I feel scared about it. I do have yearly screenings and now I Have not been screened since 9/08.
Claudette,
Thanks for writing. Without knowing where you live, it’s hard to recommend any one answer to your problem, but here are some starting points:
1) Finding a breast cancer screening cancer through the CDC:
http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp
On this site you can find centers by state. Most states has a central telephone number you can call to get referral to a clinic in your area. Perhaps there are resources available that you haven’t called yet.
2) If you are in Metro Atlanta, call Emory Health Connection:
Phone: 404-778-7777 or 1-800-75-EMORY 7 a.m. to 7 p.m. EST (M-F)
3) If you are in Georgia, call your local public health department:
To access services, call your local county public health department. Information regarding the program may also be obtained from the Georgia Division of Public Health, Screening and Treatment Program by email cabroom@dhr.state.ga.us or by telephone (404) 657-3156.
4) For additional help, call the National Cancer Institute Info Line:
Call NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237)