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Canwest News Service
I am shocked and appalled at the cataclysmic shift in the guidelines to later-age and less-frequent mammograms. This is diametrically opposite from the American Cancer Society guidelines, and from what most oncologists and practicing physicians think is needed.
Fundamentally, I do not agree with delaying mammograms to age 50, or reducing screening to every two years, or stopping mammograms at age 74. These new guidelines are detrimental to our goals of getting early detection and prompt treatment for women with breast cancer.
Even more ominous, the recommendation to start mammograms at 50 instead of 40 comes at a time when physicians are seeing younger women developing breast cancer. It makes no sense to me as a women's health physician to suddenly decide to wait until an older age to screen for breast cancer when we know that survival is improved the earlier the diagnosis is made and treatment is begun.
It makes no sense, that is, unless you realize this change is primarily designed to cut costs, not improve women's health. This is just the start of government-mandated, guideline-based rationing of health care. As has been the case my whole career, I see that women are the first group to suffer when cost-cutting takes precedent over sound medical care.
Poor women, who depend on Medicaid or Medicare coverage, will be hurt most of all since they are less likely to have the resources to get mammograms if government insurance has decided to cut back and pay for mammograms less often, or limit payment for the test based on age.
This is exactly what has happened in the government-controlled health service in Britain. British women can only get NHS coverage for mammograms every three years from age 50 to 70. The impact is that British women have about 20-per-cent lower survival rates with breast cancer than do American women.
Breast cancer is tragic and traumatic at any age. But breast cancer does not have to cause death if it is caught early with a mammogram. If caught earlier, there is a 90-per-cent cure rate for women with breast cancer in the U.S. American women have the best breast cancer survival rates in the world because our guidelines help early detection.
Cutting back mammograms to every two years beginning at age 50 and ending at age 74 is a change made by a government-sponsored panel, much like the ones being set up to decide care under the Senate and House health-care "reform" bills now being discussed.
Yet the very physicians you are most likely to see if you feel a lump: cancer specialists, radiologists and primary-care physicians were not consulted over these recommendations.
I think some of the reasons government experts have given for these changes are paternalistic and demeaning to women.
Example: It causes "anxiety" to have a false positive mammogram. So? Women are strong. Women can handle "anxiety." What is worse? Brief anxiety to find out a lump is not malignant or the greater trauma and anxiety from waiting until age 50 to have your first mammogram, only to find you have a walnut-sized cancer that's spread to your lymph nodes? Breast cancers grow slowly and by the time it's large enough to be felt, it has generally been there for eight to 10 years. Mammograms catch cancers that are too small to be felt, so treatment can be started sooner and women live longer.
I will continue to prescribe annual mammograms for my patients beginning at 40. This is sound medical practice and in each woman's best interest. And I am not going to stop ordering mammograms just because a woman reaches age 74.
Older women are just as worthy of early diagnosis and prompt treatment as are younger women. If you are the woman who is missed because the "guideline" did not fit, it's your life at stake.
Lee Vliet is a women's health specialist and author.
