New Breast Cancer Guidelines: Screen Later, Less Often
CNN/Stylemagazine.com Newswire | 10/20/2015, 1:33 p.m.
A Canadian study looked at 44,925 women who were screened for breast cancer, and 106 of them fell into this category and were treated for breast cancer "unnecessarily," according to a review in the New England Journal of Medicine.
New guidelines have their critics
While agreeing with the American Cancer Society that mammograms aren't perfect, some advocates for women criticized the group's new guidelines. First, they said the society looked mostly at studies of film mammography, which in the United States has almost been entirely replaced by digital mammography.
Digital mammograms generate clearer images and do a better job of finding cancer and have a lower false positive rate.
"It's like standard versus HD TV," said Dr. Therese Bevens, the chair of the National Comprehensive Cancer Network's guidelines panel for breast cancer screening and diagnosis, and the medical director of the Cancer Prevention Center at the MD Anderson Cancer Center.
Second, critics said the cancer society looked only at whether screening saved a woman's life, and not at whether screening caught a cancer early, so the woman could avoid the most drastic treatments, such as chemotherapy or mastectomy.
"The American Cancer Society made the value judgment that screening is only worth it if improves survival," said Dr. Marisa Weiss, a breast cancer survivor and president of Breastcancer.org. "There's an arrogance to that. Let women decide what's meaningful to them."
Insurance companies also decide
The new guidelines also state that women over age 55 can choose to get a mammogram every other year, since breast cancers in post-menopausal women tend to develop more slowly.
To a great extent it will be insurance companies that decide at what age women get mammograms. In 2009, they typically continued to pay for mammograms starting at age 40 even though the government's task for force recommended mammograms starting at age 50.
But it's not clear what they'll do now that the American Cancer Society has also raised the age for mammograms.
"(Insurance) plans will certainly take these updated recommendations into account when evaluating their coverage policies," Clare Krusing, a spokeswoman for America's Health Insurance Plans, wrote to CNN in an email.
The new guidelines are meant for women at average risk of breast cancer. The society says women with a family history or who carry a gene that predisposes them to breast cancer may need to start screening earlier and more frequently.
As for the recommendation to discontinue routine manual breast exams by doctors, many advocates for women with breast cancer agree there's a lack of good evidence that they save lives, but some said they saw no reason to get rid of them.
"It's a free and added way of knowing whether or not a lump is there," said Leigh Hurst, founder of the Feel Your Boobies Foundation.
In the end, with so many different opinions on preventing breast cancer, experts are worried women will throw up their hands.
"Our biggest concern is that this will create a lot of potential havoc in the day-to-day practice of caring for women," said Dr. Christopher Zahn, the vice president of practice activities for ACOG.
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