TO MAMMOGRAM OR NOT TO MAMMOGRAM – THAT IS STILL THE QUESTION

TO MAMMOGRAM OR NOT TO MAMMOGRAM – THAT IS STILL THE QUESTION

Welcome back to #WELLNESS WEDNESDAY everyone. Today we’re going to return to an old topic of great importance. Yes, ladies, here we go again!

Mammograms and guidelines. When do we start having mammograms? How often do we have them? Are they really effective? Do they really save lives? And the biggest question of all:  Will the medical community ever make up its mind?

As you recall, mammogram screening has been a tricky topic for years. I wrote about mammogram screening guidelines two years ago when the guidelines abruptly changed. And, I wrote that the one thing we could always count on was that the guidelines would change again. And, so they have – and here we are.

The huge controversy concerning mammogram screening began in 2009, when the US Preventive Services Task Force, or USPSTF, said that most women should wait until they are fifty to get regular mammograms. The Task Force also said that screening only needed to be conducted every other year.

This idea flew in the face of then accepted guidelines that said most women should begin regular mammogram screening at forty and repeat the procedure every year. General uproar ensued. Then in 2013, the debate reached a new fever pitch when yet another study was published recommending we return to the previous guideline in which forty is the proper age for women to begin screening.

Last week, however, the guidelines changed yet again. And, this time it was the American Cancer Society that changed its recommendation from yearly screening for women age forty and up – to women aged forty-five and up. The USPSTF still stands by its recommendation for screening of women aged fifty to seventy-four every other year. While the American College of Obstetricians and Gynecologists or ACOG sticks with its recommendation of screening for women aged forty and up every year.

Wow. It’s all very ironic considering a guideline is supposed to reduce confusion — not increase it.

So, let’s dissect this mess. After all, we’re talking about our lives and it’s incredibly important we understand what’s going on.

For most of the last twenty years or so it was generally accepted throughout the medical community that mammogram screening for women should begin at the age of forty for women of average risk. It also was accepted that this screening procedure should — in most cases — be repeated once every year.

Now, this guideline remained unchanged until the 2009 report by the USPSTF, which stated that women should not begin mammogram screening until the age of fifty – and then only once every two years. So, why after so many years of substantiated guidelines did the USPSTF say this? There were two main reasons.  The first was that screening women at the age of forty didn’t save enough lives to justify the expense of screening.  The second was that screening women at the age of forty exposed women to needless worry and unnecessary procedures that might result from false positive results.

Let’s talk about the first reason. This logic is based upon something known as a cost/benefit analysis. The Task Force decided that not enough of us die from breast cancer between the ages of forty and fifty to make it worthwhile to provide the mammograms that might save us. You see, mammograms cost money. Someone has to pay. And, typically it’s either the government, the medical facilities or the insurance companies.

This is a point of contention. Let’s take an example. Let’s say 500 of us are in the middle of the ocean on a burning ship. A rescue team could save us, but decides not to. They contend that because there are only 500 of us, mounting a rescue would be too expensive and not worth the effort. It would make more ‘CENTS’ to let us die and save the money rather than save our lives. Now, let’s suppose there are 5,000 of us on that burning ship. At this point, a decision to launch a rescue might be supported — because saving 5,000 lives might justify the amount of money the rescue effort would cost.

Ladies, how does that make you feel? Don’t you ever wonder who makes up these Task Forces? Are there any women on them? Don’t the men on them have any women in their lives? Wives, daughters, sisters or mothers? It’s something to think about. In any case, that’s how a cost/benefit analysis works.

Now, let’s talk about the second reason. It’s true that mammograms are not infallible. Sometimes they fail to see a problem that exists. Sometimes they reveal a suspicious spot that turns out to be harmless. This is called a false positive. When women begin screening earlier, more mammograms are conducted. When more mammograms are conducted, the number of false positives may increase.  When the number of false positives increases, more women may experience needless worry. And, more women may need to undergo a biopsy before they know the positive result is false.

According to the Task Force, this unnecessary worry is unacceptable –as is the unnecessary medical procedure these women may have to undergo.  Now, here you need to remember — the medical procedure typically is also paid for by one of the above-mentioned entities. So, we’re talking about more money that someone doesn’t want to pay out. As a result, the USPSTF concluded that women should just wait until they’re fifty for screening and to repeat it every other year. Saves everybody a lot of trouble.

I don’t know about you, my friends. But, I would rather be alive and experience a bit of needless worry and temporary discomfort — than be dead because I didn’t receive a mammogram that might have saved my life.

Indeed, a mammogram did save my life. And, as many of you know I have always adhered to the guideline still supported by the ACOG, which says most women should begin mammogram screening at the age of forty and should repeat screening once every year. And, this guideline is supported by research from Harvard Medical School, which conducted studies based upon the number of women who had never undergone a mammogram and died of breast cancer as a result.

It’s also good to know that current health care law in the United States requires most insurers to pay for screening mammograms once every twelve months without charging patients a co-pay. In addition, Medicare and Medicaid also are required to cover the cost of yearly screening mammograms for their patients. 

But remember, what is best for one woman may not be best for another. There are many factors to consider before adhering to a screening routine that makes sense for you – which makes this, of course, an excellent topic of discussion for you and your primary care physician.

Moreover, high-risk women who have a history of breast cancer in their family, women who have a first degree relative who has or had breast cancer, women who have an anomaly of the BRCA 1 and 2 genes and women who have certain physical characteristics like fibrosis of the breast will in all likelihood require screening earlier and more frequently than women of average risk.

Hopefully, this helps shed a bit of light on a controversial and confusing topic. And, as I said last time, the one thing we can count on is that another study will come along in the next few years that once again will change the guidelines for breast cancer screening. So, until then do your homework and always take a PROACTIVE APPROACH to your health!  BE INFORMED, BE COURAGEOUS and BE BOLD. Your life depends on it!

Thanks again for joining me everyone! Until next time,

TAKE THE COURSE AND TAKE CHARGE!

Revised from my guest post on It’s a Glam Thing for Breast Cancer Awareness Month, 2013.