Maine breast cancer survivors, doctors question starting mammograms at age 50

Maine breast cancer survivors, doctors question starting mammograms at age 50


By Meg Haskell
BDN Staff
BANGOR DAILY NEWS PHOTO BY KEVIN BENNETT
Cancer survivor Jeni Lloyd recalls a a friend and cancer patient that died this past January. "We need more screening tools earlier, not later," said Lloyd at her Hampden home on Wednesday, November 18, 2009. Buy Photo
BANGOR, Maine — Breast cancer survivor Jeni Lloyd was "quite astounded" by the news earlier this week that a powerful national health panel has recommended a significant reduction in the use of mammography to detect breast cancer in women.

"This sets things way, way back," the 43-year-old Hampden resident said Wednesday. "It is crazy to take away something we know is effective in the early detection of breast cancer."

Lloyd, who was just 39 when her cancer was diagnosed, is not alone in her dismay. Now cancer-free and serving as the vice president of the Maine chapter of the Susan G. Komen Breast Cancer Foundation, Lloyd said her Facebook page is filled with comments from Maine women, including many cancer survivors, expressing their anger and frustration.

“People are very concerned that this is a wrong decision,” she said.

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The new recommendations from the U.S. Preventive Services Task Force were published online Tuesday in the Annals of Internal Medicine. The group recommends against routine mammography in women under 50 except in high-risk cases; current guidelines call for annual mammograms starting at age 40. The new recommendations include a mammogram every two years for women between the ages of 50 and 74, instead of the currently accepted annual test.

And the panel says clinicians should not encourage women to perform breast self-examinations to search for small lumps that might be cancerous.

The group found that more frequent use of mammography does not effectively increase the number of women who survive a breast cancer diagnosis and that “false positive” results can lead to a host of medical complications, including high levels of anxiety as well as unnecessary surgery and treatment.

The report has drawn fire from the American Cancer Society, the American College of Radiology, the American Society of Breast Surgeons and other groups, including some who say it prioritizes cost-cutting in the nation’s health care system over patient well-being.

But other advocacy groups, including the National Breast Cancer Coalition, Breast Cancer Action and the National Women’s Health Network, have endorsed the findings.

“We have suffered from oversimplification of the breast cancer early detection message for far too long,” said Breast Cancer Action president Barbara Brenner in a statement on the organization’s Web site. “The new recommendations on screening may help us move to a more nuanced understanding of breast cancer, and ultimately ... a better place for all of us.”

But Dr. Merrill Garrett, a medical oncologist at Eastern Maine Medical Center in Bangor, said Wednesday that she will not change her own recommendations anytime soon.

The national task force is highly respected, but “not on the frontlines of treating breast cancer,” she said. “They’re not the ones who are seeing the 40-year-olds who, had they not had their mammograms, would have been diagnosed at a much later stage in their disease,” Garrett said. The more advanced a cancer diagnosis is, she said, the more it costs to treat and the greater the likelihood that it will prove fatal.

“I’m not sure who gets to make the decisions about whether the number of lives saved [by early detection through mammography] are enough,” she said.

While it is true that a certain number of false positives will result, Garrett said responsible hospitals and medical groups are diligent about deciding which tests call for biopsy, surgery and further treatment. At EMMC, a multispecialty group meets weekly to discuss new cases and to review the handling of older ones, she said.

“This really seems to be a cost issue,” she said about the recommendations. “I’m not sure that targeting 40- to 50-year-olds is the best way to get at that cost issue.”

Across town at Penobscot Surgical Care, surgeon Kimberly Lieber agreed. “This is absolutely based on economics and not clinical data,” she said of the new report. “But it is penny-wise and pound-foolish.”

Dr. Lieber said there have been many recent improvements in clinical approaches to breast cancer, including digital mammography and new treatments and procedures based on the early detection it provides.

“This is a turning back of the clock,” she said. “It obliterates the advances of the last 30 years.”

At the Maine chapter of the American Cancer Society, vice president Kip Deserres said the organization also does not endorse the report.

“We are sticking by our current recommendations of annual mammograms for all women starting at age 40,” he said. “This study is not compelling enough to change our basic recommendations.”

As for breast self-exam, Garrett at EMMC said it seldom proves more effective than mammography at detecting early-stage cancers.

“But the more familiar women are with their breasts and what’s normal for them, the better,” she said. “It certainly doesn’t hurt. It’s easy and it doesn’t cost anything.”

A primary concern is that insurance coverage for mammography will change to reflect the new recommendations, meaning fewer women will opt for annual testing, even if their doctors recommend it.

“It will first affect Medicare, and then the private insurers will follow suit,” Lieber predicted.

A call to the Maine Association of Health Plans for comment was not immediately returned.

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Comments
41 comments on this item

Can anyone say DEATH PANELS

Government rationing healthcare??? Pres said it wouldn't happen. It already has......

I knew Cristy. (The "girl" on the pink placard). She was active in Sue Komen, and so many other positive endeavours. She left behind a wonderful husband, family and a beautiful black lab named 'Toby". She was SOLID GOLD. It touches all of us and please give until it hurts. She was to young...

Wow...one of would have expected the all-knowing, all-caring publicplanophile-in-chief and his minions would have targeted a far less visible and compelling health issue to make his first foray into rationing. And this guy graduated from Harvard? What were his grades, after all? Oh, yeah...that's right - he's not telling.

When I first heart this news, I had to wonder if they were moving away from Mammography and more toward Thermography, as Thermography is proving to be more accurate and can find areas in the breast that will turn cancerous long before cancer becomes a problem. In this article, it sounds as though they are moving toward digital mammography and are pretty much turning their backs on a segment of the population that is at highest risk. The younger one is when they get cancer, generally the more aggressive it is.

I was completely shocked when it was suggested that women not do their self breast exams. That statement is a very irresponsible one at best. There have been 4 women in my own family who found their breast cancers by self-breast examinations, and I know of many more women who found their cancers the same way.

You might think that linking this study to warnings Obamacare critics make about health care rationing is overdramatization. But actually, this Wall Street Journal editorial http://online.wsj.com/article/SB10001424052748704204304574543721253688720.html points out that cost concerns were a higher priority with this new study. Previous studies by the panel with a lee cost-centric approach agreed with the conventional wisdom about mamograms. It also points out that there are no oncologists or radiologists on the panel.

"Change is coming, we can do it....we can do it......! How do ya like the changes people?? The beginning of Obamacare, and nothing has been "passed" yet!! Obama ssuuuuuuucks!!!

This is an Obamination.

I refuse to die because my hard-earned healthcare benefits were mismanaged by the government. Unfortunately, my voice is not important. This is the beginning of the end for hundreds of thousands of Americans unless we stop it now.

To make it short and to the point - This story is more about the insurance companies attempt to save millions - Their underlying goal is simple - Of the 1 to 5 % of women that die from breast cancer between the age of 40 to 50 is collateral damage - but we can save billions - This is paramount to years ago that we were told by the insurance companies --- if we all wear seat belts - it will save lives -- and your insurance premiums will go down -- essentially it boils down to this --- the insurance companies want you to pay your premium every month -- but they don't want you to use your insurance -- kind of like offering a donkey a carrot but never letting him eat it -- I say get yourself checked regularly -- especially if there is a family history -- thinkaboutit

I would like to add - with cancer being on the rise and millions raised every year for breast cancer research --- I can't help but wonder when I see these TV clips of doctor's viewing x-rays using a magnifying glass -- what's up with that !!!!!! -- Looks pretty out of date -- all you have to do is watch some of these other shows where they have computer point matches for finger print identification - facial identification - with all the billions of dollars raised by the public -- you mean to say we don't have a computer that can scan an x-ray to identify possible breast tumors -- You have to wonder where all that money is going year after year - I'd like to see some accountability -- Thinkaboutit

Here we go..the talk of saving money from medicare has already begun by rationing what the panel deems an unnecessary expense. Just wait until the health care bill is passed! I wonder what will be next? How many times do you hear of women in their 30's and 40's getting breast cancer! They are often the ones more likely to die at a young age, but with this plan, there leaves now doubt!

Another offshoot: I talked to my doctor after he performed a prostate biopsy when my PSA went from 2.3 to 5.0. I asked him what he thought of government health care. He said he only made 8% profit margin on Medicare/Medicaid as it is. With the proposed 23% cut to these programs, he said he can not afford to treat the patient for free and actually lose 15%. He said he would stop taking government programs and go to either insurance or self-pay. He said that 2/3 of his patients would likely have to find another doctor. He continued that he would cut his office staff accordingly, and most likely get another physician to come in with him so they could split the costs of the practice. My primary care doctor said basically the same thing. He said he would most likely retire, or just take self pay patients or insurance patients.

I suspect the number of practicing doctors will decrease if this plan passes. Think about all those patients who never could afford a doctor suddenly wanting appointments. He said care would be rationed by the fact, that you will most likely wait months for an appointment because of the flood of new patients. He said it would take almost 10 years just to train the number of doctors we will be needing. He smiled and said, be prepared to speak another language when you see your doctor, as there would be a flood of foreign doctors coming in the US.

Sounds to me like this "panel of medical experts" mostly men? are looking for ways to cause the death of more women. In the last 10 years 98% of the people I know who have had cancer, 97% died got it in their 30's and 40's.

Is the war not killing enough people? I think politics need to step away from health care.

From all I have seen with cancer it looks to me like it's a money making scam and in the last 30 years the advances are so small, it's insulting. Makes you think the government ,insurance companies put cancer cell in shots to kill people off.

I too would like to know where all the money people donate to research is going, there has been cancer organizations since the 1850's to battle this. But hey the USA had to crash a millions of dollars with equipment on the moon to see if there is water, more important than cures.

You NEED to show up at the State House in Augusta people... rally together before this gets out of hand!!!!

I agree that this report is inaccurate, misleading, and is apparently a self-serving ploy by the health insurance industry. The basis is obviously purely cost analysis and no thought for effect on pateinets and their families.

My wife and I have seen attempts like this happen years ago (in another state) when my company switched to a new health insurance coverage carreir. The insurance reps were giving a series of presentations to employees and spouses. When one rep (a female nurse, no less) was asked about mammogram coverage and the state regs requiring its coverage, she flippantly said, "We have ways to get around that". In the resulting uproar, she was demoted to a desk job and mamograms were covered.

It's still not obvious what relationship this task force had to the government (or which administration). Too bad this article was prepared before HEW Secy. Sebelius [sp?] came out with her contradicting advice that women as individuals consult with their doctors for the best practive for them. If you don't trust your doctor, find another.

The Secretary's opinion is apparently that of the current adminsitration. Those who dislike Obama (note I didn't use the "H" word although it might have been apporopriate) should regard the Secretary's statements as reflective of adminstration policy (as we all should). The real battle is going to be with insurance compnaies but without a unified national plan, that will have to be done on a company by company basis. Complaing to Augusta will only influence contracts with Anthem and a few others. Neccesary but far from sufficient.

For those saying these findings are generated by insurance companies, here is a link to the members of the panel. Not one person is from an insurance company.

http://www.ahrq.gov/clinic/uspstfab.htm#Members

IMO these are people who were appointed by the present administration to find what that admin wanted them to find.

And this

http://www-dep.iarc.fr/

is a link to The World Health Organization. Here you will find results of the most up to date (Globocan 2002 database) worldwide studies on cancer survival rates by country. The UK shows death rates from breast cancer of 17.7%. The US is at 15.9%. not a huge difference unless it's you or your loved one. Should we save money by letting women die?

For our leaders to tell us we should get in line with the rest of the world with healthcare is the dumbing down of healthcare in this country.

Across town at Penobscot Surgical Care, surgeon Kimberly Lieber agreed. “This is absolutely based on economics and not clinical data,” she said of the new report. “But it is penny-wise and pound-foolish.”

A primary concern is that insurance coverage for mammography will change to reflect the new recommendations, meaning fewer women will opt for annual testing, even if their doctors recommend it.

“It will first affect Medicare, and then the private insurers will follow suit,” Lieber predicted.

I repeat my comment from yesterday. This panel of Government accountant/Doctors are making money choices for medicare anjd other US government insurances. This kind of cost benefit analysis on the part of the government will happen on a much more regular basis in any National Halth Insurance Public plan.

Your healthcare and your choices will be made in a line item of the federal budget.

Thinkaboutit Remember this is a Government recommendation not an Insurance company recommendation. TYhis is recommendation for Medicare & any other government run health plans.

Here you go people. The bill hasn't even dried yet in the house and we have govt panels now telling women what they should do for their health. Your first taste of rationing....what will be next? No testing for prostate cancer until you are 65? What if they end up coming out with asinine rules like this, which for those of you who say oh no, what then? You didn't listen to the pres very closely when he TOLD us that the govt would be better capable of telling YOU whether you should be treated with pils rather than have an operation to correct a problem. THEY will make the determination...you don't have to believe me...go look it up. But, some think this is what they want...good luck!

And any woman who thinks she will be able to get a referral from her doctor to circumvent guidelines without meeting criteria of high risk is naive, That statement was pure back peddling and is intended to soothe us and give us a false sense of security. Dotors need to meet certain criteria now in order to give a referral, this will be no different.

First off, this has nothing to do with Obama. He was not involved in the study and was not on the committee that made this decision. Secondly, the panel making these reccomendations is not government affiliated, nor are any of the members oncologists. And thirdly, The Health and Human Services secretary makes the final decision on what the guidelines should be when it comes to healthcare....not some advisory committee.

My mother was diagnosed with breast cancer at 31. What do you think would have happened if she had to wait until 50 to get a mammogram?

MainnerinTn...it is a group appointed and funded by the U.S. Govt. And if the Health and Human Svcs Secretary uses "guidelines" by these people..who are appointed and funded by..THE GOVT...to come up with these ideas and findings...what makes one think once govt run healthcare is in place that these 'guidelines" won't be acted on? It has everything to do with Obama, he is going to depend on what these same types will tell him. As I said earlier, HE, OBAMA, said that a group such as this will be making decisions on what will be correct for you. And your Mother was very lucky that these people weren't in place then.

Bottom line is that it comes down to money. Giving younger women the shaft when it comes to preventitive care is not the place to start. You can bet if we were talking about prostate cancer, this would be a very different story.

There was once a powerfull leader named Hitler that told millions of Jews they were just going for a "train ride." This healthcare bill is a tragic "train ride" for millions of Americans. Stop it now!!

To compare this to the Holocaust is inexcusable. Troll-like, inflammatory remarks like this should not be allowed to stand.

Some people say that the Holocaust never happened......

No doubt this has to do with money, this will save Billions for the Govt when they take over health care,

"Some say the Holocaust never happened."!! Sure....just ask the relatives of those in the camps; those that have actual brands on their bodies from their time there. Only very ignorant people would ever question , or deny, the Holocaust and the horror that occured there.

I hear you Cher.

There seems to be quite a bit of proof...

anne, this is an adult forum. If you can't handle it, simply log off. Or try growing up.

Surviors of breast cancer should wear our pink ribbons upside down in protest of this finding. My first bout was in 1988, no family history, I was 39.

anne_of_mdi this is very much like what Hilter did, go to the library and read how Hilter got started.

I know too many women who had breast cancer in their 30's, if you read the obits check out the ages of those who die from cancer, it's getting younger all the time.

Never ever listen to the U.S. Preventive Services Task Force even the name sounds evil. I sent this article to all my friends all over the country.

Government run health care at its best....just waht we all need, the government running more of our lives...don't blame me, I didn't drink the OBAMA koolaid.....

Let's hope that Jeni Lloyd and others who are head of the Susan Koeman chapters in other states, and other breast cancer organizations will go to Washington for a rally on this one!!! I can assure you that millions of victims of breast cancer as well as their families and friends, will show up too.

We can't afford to sit back and do nothing, while others decide the fate of those who are diagnosed with this disease.

I've seen a lot of comments about this being an Obama issue. But the United States Preventive Services Task Force has been in effect since 1984. I've worked within and without the US Government and while I could be wrong it is unlikely that this recommendation started less than 1 year ago. Most of these studies take 2-4 years of work before they are published. Some times their recommendations are supported by the medical community and sometimes they are not. Their job is to look at the numbers without bias. I'm not weighing in pro or con on this issue, but I know the USPSTF has come out against other "common sense" approaches that research has shown aren't common sense at all.

So who will pay for the cameras installed in our bathrooms to make sure we Don't do our self exams? And what will be the punishment if we do? How many will be hired to monitor the cameras? Get in line, fellas!

Who would have thought this national health panel could have so many knuckle heads in one group? I have a shocking history of breast cancer in my family so I get mammograms every year. I'm a three time survivor of breast cancer thanks to early detection by a mammogram. I wonder where I'd be without my yearly mammograms? Six feet under maybe?

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