Streams

Mammogram Confusion

Friday, November 20, 2009

A federal advisory panel and the American College of Obstetricians and Gynecologists made controversial recommendations this week for women to delay breast and cervical cancer screenings. Gina Kolata, science writer for the New York Times and author of Rethinking Thin: The New Science of Weight Loss--and the Myths and Realities of Dieting, provides analysis.

Guests:

Gina Kolata

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Comments [36]

Roberta from Tennessee

Part 2 (continued) Here is my question: Will BCBS of TN drop me if I get a Thermography? BCBS of TN does NOT cover Thermography exams. Also, if anything is found, will BCBS demand that I get ANOTHER mammogram to PROVE that the Thermography found something. Here's the catch...Thermography finds suspicious areas WAYYYYY before a mammogram will, so therefore if I did subject myself ONCE AGAIN to a 13th mammogram and they found nothing, then I have not only increased my chances again but I have wasted time and money and may still have a problem that the mammogram would not see. I really and truly do not believe anything will be found, I live a very healthy life, exercise, etc. I am also a very positive person and do not dwell on negative thoughts, that is essential in any area of having a healthy mind AND body. But still, I am even afraid to call BCBS because they record and document every single thing you say on the phone or do on their website. My mother got dropped from her insurance in the 90's when she was diagnosed with terminal pancreatic cancer...THAT is why I am so paranoid about insurance companies. Btw, I HAVE called BCBS, they said they do NOT cover Thermography but I stopped with any further questions at that point and did not have the nerve to ask them if they would drop me if I got one. Anyone out there have any advice?

Jan. 30 2010 11:12 AM
Roberta from Tennessee

Part 1) I have had an annual mammogram since I turned 40, which now adds up to 12 mammograms over 12 years. I thought I was doing the best thing for my breast health. However, last year I went to a different doctor who is board certified internal medicine/preventive medicine doctor. He was very adamant that I stop getting mammograms yearly and opt for Thermography, because every time you expose your breast to a mammogram you INCREASE your chances of breast cancer by 1%. So that means, two breasts = TIMES 2, so that means I have increased my chances of cancer by 24%! He said women are exposed to 1000 times the radiation that a person gets when they get a regular chest xray! (to be continued)

Jan. 30 2010 11:11 AM
Susan Lacina from North Brunswick NJ

I am a breast cancer survivor 17 years. I was diagnosed at the age of 38 by having a mamogram. Early detection was a plus, for I had a lumpectomy, lymph nodes removed and radiation therapy. Be sure to see a specialist in this field and seek a second opinion on your surgeon for the first one I spoke with said he could go in and cut out whatever I wanted or wait six months to see if it grew! A needle biopsey showed it was cancer and yes my surgeon who was also female was proud I got a second opinion and did not wait. Life is to short for you not to take the time to evaluate your health and God Bless the Radiologist who read my mamogram and suggested I see my gyno. and a surgeon.

Nov. 21 2009 12:42 AM
Mark Kinnane from Cape Cod Mass

I think the research is missing the point. My partner I met in 1995 and was diagnosed ( spotted with a Mamogram) with Breast cancer would fall into your catagory that it didn't help. Why because she died 8 years later.But with the help of kemo she lead a fairly normal life for 5 of those eight years and even the last 3 she or I wouldn't have traded them for anything. We have four children from previous marriges and Shaundi raised them with some help from me. Our children's life's would not be the same without those years with her. My point is simple the study is flawed without taking into account the years early detection can possibly add to someones life. I have re-married last year and my wife will get one every year. Even though my Blue Cross blue shield policy no longer covers them and we pay $500.00 per year for her test. Is it worth it Damm right it is.
Thanks Mark

Nov. 20 2009 01:43 PM
Eugenia Rensskoff from Williamsburgh, Brooklyn

I feel that all women should get a mamogram once a year and that it should not be a question of money, money all the time. Personally, I am more comfortable having my breasts examined regularly just in case. Eugenia Renskoff

Nov. 20 2009 01:07 PM
Dianna from NYC

Why undo all of the public education regarding mammograms of the past twenty years now going on three generations of women? After all of the PSA’s, television programs, not to mention the countless thousands of articles in women’s magazines, would the medical profession want to change the behavior of women as far as their reproductive and breast health?

Why? So in another ten years they can say – “Oops we were wrong, forget that recommendation and go back to the yearly exams”.
Same for self-exam? Why discourage women from doing that? I know more than several women who sought medical attention after discovering a bump or a lump. In some cases, it turned out to be nothing; in others it turned out to be a situation that needed treatment, two that needed aggressive treatment.

Nov. 20 2009 12:03 PM
Pam, M.D. from NY

1: No.
2: It has: http://mp.medscape.com/cgi-bin1/DM/y/hCjNj0VLMsw0Euh0KmbK0GA&uac=122158BZ
4. The Obama admin. has told women to continue their routine screening; and, that it will pay for them to do so.
5. The recs were generated without regard for costs. See reply to #4, above here.
6. Yes. Mammographers know well the data.
7. These recs don't come from the gov't..
10. Way wrong.
19. No changes in recs for you.
26. See replies to #4 #5, above here.
27. No.
30. Liability issues were not aken into account.

If you can take the anxiety, GET YOUR MAMMOS YEARLY FROM AGE 30! Anxiety over a false-positive is nothing compared to anxiety from a diagnosis of cancer.

Nov. 20 2009 11:59 AM
Jimmy from Passaic, NJ

I tried to call in.. but got in too late... There is a bigger issue here at hand... that I'm surprised your guest and no one else has brought up. And that's how the liability and poor reimbursement rates have drastically decreased the availability of sites administering Mammo's. I've worked in Radiology for over 6 years, and both centers I worked for stopped administering Mammo's due to poor reimbursement rates, and high liability issues for the center and radiologists reading mammo's. Less availability of mammos is having a greater impact on women getting checked than any change in age recommendations. The question is, are these Recommendations in age changes Part of the medical community to reduce liability issues to health care providers by minimizing negative results and biopsys and part of insurance companies trying to decrease the cost for radiology services by cutting the number of mammos, Mri's Ultrasounds administered? You should revisit this issue from the angle of Mammo Availability and the liability issues that referring physicians, and Radiologists are facing with Mammo's

Nov. 20 2009 11:54 AM
William from Battery Park City

Can you imagine the outrage if these recommendations would have taken place under a Republican Administration?

Nov. 20 2009 11:53 AM
Pam, M.D. from NY

There's a very good NPR discussion on this here: http://www.onpointradio.org/2009/11/mammograms-medicine-and-healthcare

Nov. 20 2009 11:44 AM
susan sonz from tribeca

This is a question-
are the experts suggesting that unnecessary biopsies play some part in future development of breast cancer? In other words, does a repeated injury to the site (two or more biopsies) cause cancer?
Women who suffer from cystic breast disease have been subjected to repeated needle biopsies and cyst removals and this issue is not yet being discussed.
thanks

Nov. 20 2009 11:36 AM
Mike from Inwood

Questions are raised regarding the morality of not recommending mass screening simply because so few lives are actually saved. The 800-lb gorilla in the room is obviously whether this is simply a cost-saving measure and whether the few women whose cancer would not be detected in time are being sacrificed to save money. Perhaps the cost of mass screening might be compared to how else the same money could be spent and how many lives could be saved if it were devoted to some other part of medicine. Of course, if you there is a history of cancer in a woman's family or some other medical reason why she should be tested, exceptions to the under age 50 screening should be routinely granted if mass screening were discontinued. Some may think this is callous reasoning by a male who would not be affected, but I say this as the son of a woman who died of breast cancer before the age of 60 despite the yearly mamograms provided by her 'cadillac' public service health plan. Mamograms failed to detect the 'web-like structure' of her cancer; she had no lumps.

Nov. 20 2009 11:34 AM
Madeleine from Manhattan

You might wonder how much time it takes for a doctor to show a woman how to examine her breasts. You might also be interested to know that the average time of a woman's annual OB-GYN exam is 6 minutes. I'm not kidding.

Nov. 20 2009 11:28 AM
Pixxxao from Brooklyn


What about getting a baseline for Testosterone and Estrogen levels as well as free "T" and PSA levels in males at or around age 40.
Why is Prostate cancer so underrated?

Nov. 20 2009 11:27 AM
superf88

great comments and questions here...

Nov. 20 2009 11:27 AM
Pam, M.D. from NY

Also, re.- the guest's statement that "with false positives, women don't know whether the radiation or chemo that they've gotten has been necessary," again: she could not be more WRONG. No tx is ever given without a definite diagnosis from biopsies and other studies.

Pam, M.D. from NY November 20, 2009 - 11:22AM

Bri- Your guest could not be more wrong about several of her statements on mammography.

The recs in question concern ROUTINE screening; in women who have family histories of breast ca, the rec is for much earlier screening.

The only studies of the effect of routine screening of women who are in their 40s come from Sweden, where they have proven a 40% increase in survival.

Nov. 20 2009 11:27 AM
Pam, M.D. from NY

Also, re.- the guest's statement that "with false positives, women don't know whether the radiation or chemo that they've gotten has been necessary, again: she could not be more WRONG. No tx is ever given without a definite diagnosis from biopsies and other studies.

Pam, M.D. from NY November 20, 2009 - 11:22AM

Bri- Your guest could not be more wrong about several of her statements on mammography.

The recs in question concern ROUTINE screening; in women who have family histories of breast ca, the rec is for much earlier screening.

The only studies of the effect of routine screening of women who are in their 40s come from Sweden, where they have proven a 40% increase in survival.

Nov. 20 2009 11:25 AM
Estelle from Austin

If we're not supposed to do self-exams, and we're not supposed to have mammograms, then how is cancer EVER to be found at all?

Nov. 20 2009 11:25 AM
Sarah from Brooklyn

Wondering why no one has addressed the difference in recommendations for women with a family history of breast cancer. I am 29, my mother had pre-menopausal breast cancer and my father's mother had breast cancer as well.

Previously, my doctor recommended I may want to begin screening at age 30. I am concerned this seems to be a blanket recommendation and not taking into account vast hereditary differences.

Nov. 20 2009 11:24 AM
Rebecca Berenson from Manhaattan

What are guidlines for women over 70?

Nov. 20 2009 11:23 AM
Rebecca from Manhaattan

What are guidlines for women over 70?

Nov. 20 2009 11:23 AM
katie from east village

I recently heard dr silvia formenti of NYU explain the issue very well--that screenings find all tumors--many that are harmless--and that even of the malignant ones, THE OUTCOME OFTEN ISN'T CHANGED EXCEPT that a woman is living longer with the stress of having cancer

Nov. 20 2009 11:21 AM
Jane from Brooklyn

Honestly, I often find it pretty infuriating when the doctors say to you: oh, this is your decision to make. We didn't go to medical school,
how can we make qualified decisions about what seems to be life and death situations in some cases. I have fibrocystic breasts, and have had to go through ordeals of annuals and sometimes semi-annuals mammograms/ sonograms since my mid thirties. I've had 4 (!) biopsies by now, all negative. I've begun to question the wisdom of doing it a while ago. Still, it seems to me that by putting decisions in women's hands doctors simply want to duck responsibility

Nov. 20 2009 11:17 AM
csh from NJ

Scientists around the world have been arguing against the relative benefit of regular mammograms for many years. A number of documents (PDQs) that came to similar conclusions have been available online at the NCI for many years.

I'm concerned that there is not more discussion empowering women to take action during the years they're not testing, as well as during "watchful waiting."

Become vitamin D replete, eat more vegetables, reduce sugar, lose weight and exercise to decrease risk.

Nov. 20 2009 11:16 AM
Lola from canada

The new guidelines in the US (for both mammograms and pap smears) are the same we've had here in Canada for many years! Cancer rates are higher in the US than they are in Canada... I think Americans should spend more money and effort on prevention that on precancer screening.

Nov. 20 2009 11:10 AM
allsion from brooklyn

This isn't quite a "women's" issue...they just said the same thing about detecting prostate cancer last year.

I'm sure we could catch breast cancer if you started screening at age 21 too...but that was never what we did.

Nov. 20 2009 11:09 AM
Sophie from manhattan

Thermography is way better than mammograms, esp. in women under 50 when the breast is often denser. Fewer false positives and less radiation. I've always thought the medical establishment pushed mammos way too much anyway.

Nov. 20 2009 11:08 AM
RJ from brooklyn

Please address the difference between "recommendations" and "guidelines." The task for recommendation on mammograms includes recommending that doctors and patients discuss; guidelines, I believe, are what doctors follow when making recommendations.

And I'd lay odds, in our sound bite culture, this distinction will be totally lost. As has been the "recommendation" aspect of the mammogram proposal.

Nov. 20 2009 11:07 AM
the truth from BKNY

Why does society panic about every darn thing? This is a no brainer! If you have history in your family, then you do NOT change the frequency except to increase screenings! If you are a reasonable person between 35 and 49 then you get one of each every year or certainly every other year with your physical. What is the confusion all about?

You don't have to drink the kool-aid just because they put it in front of you!

Nov. 20 2009 11:06 AM
Brian from Bronxville, NY

I’m confused by the out-lash against the recommendation that women get regular mammograms after 50.

Generally speaking, Americans have grown skeptical of the government and even developed a cynical attitude towards government recommendations. This is evident in the wild criticism of elected officials on both sides of the aisle. There seems to be a sense that if we’re being represented by someone we didn’t vote for (or who was appointed by someone we didn’t vote for) then we are being represented by a fool.

So, why then are some people having such a reactionary response to the government’s recommendation about mammograms? Why isn’t cynicism being employed here? No one is saying “don’t get mammograms before 50 or you’ll be locked up!” there just changing the recommended age for regular mammograms. And, if people hate the recommendation why don’t they just ignore it and do what’s right for them? Perhaps I’m merging partisan politics and personal healthcare choices…?

What truly angers me, however, are responses from the news media. Immediately there were clips of Christina Applegate (who had a double mastectomy) on the news saying that a mammogram saved her life. I think the clip was from an interview she did months ago and I’m thrilled that it saved her life but she needed this type of early mammogram because of her family history. Worse though, was that lunatic from The View saying that this was “gender genocide.” Not only is she way off, but it doesn’t seem like she knows what genocide means (true genocide would be much more direct) nor did she appropriately use the word gender; gender denotes behavior and identity, whereas sex is anatomical. And why were all the major news agencies (WNYC excluded of course) giving her more airtime by rerunning that clip from The View over and over again?

Nov. 20 2009 11:02 AM
Judith Knipe

Have any studies been conducted to determine the relative accuracy of MRIs versus mammograms, both in terms of false positives and the actual discovery of tumors, either benign or cancerous?

Nov. 20 2009 10:58 AM
Josh from Brooklyn

here's the thing. I'm not a doctor, so I really don't know how often one needs a screening. Is the status quo the right way or not? Personally, my gut tells me it is. The truth is, this is a way to cut costs. These tests are very expensive and contribute to high premiums. The republicans blame the democrats for overspending, and not only do they have no plans to keep costs down (selling plans across state lines is a joke), they blame the democrats for doing just that. It is just a political football for them and another glaring case of hypocracy.

Nov. 20 2009 10:00 AM
superf88@gmail.com

Other existential questions one can only assume are the real drivers here:

-Is cancer so easy to defeat that catching it a few years earlier isn't significant?
-Or, is a cancer diagnosis so hopeless that, as was asserted earlier this year regarding prostate cancer, catching it early is not beneficial?
-Are American women too emotionally fragile to be tested for cancer?

"Mammogate" (coined!) will do for Obama's Health Care reform what Bush's dumb dumb idea of forcibly binding Social Security to the stock market and Wall St brokers did for Social Security reform.

Nov. 20 2009 09:39 AM
nora herting from Brooklyn

I am surprised at how politicized something as simple as screening recommendations have become.

Personally, I wish the new Pap recommendations had come out 10 years ago and spared me a decade of unnecessary and invasive Pap tests.

This week I illustrated two of the stories around these new recommendations on my blog, Line by Line, a daily graphic capture of a New York Times story:
You can see my visual interpretation here:
http://blog.imagethink.net

Nov. 20 2009 09:26 AM
superf88@gmail.com

Jill -- agree, that sounds like the elephant in the room. I have been waiting for the full page NYT ads being taken out by the "radiology community" for their full throated argument, but it ain't coming.

A conspiracy theorist might conclude that this report is a compromise following a different study suggesting how horrible x-rays are, especially over many decades as Americans live longer.

Nov. 20 2009 09:24 AM
Jill from Westchester

Why hasn't the risk of the test itself (apart from the risk of a false positive) been included in this conversation? Exposure to radiation is dangerous. Repeated, annual, localized exposure is more dangerous. Reducing that exposure is a good step toward better health.

Nov. 20 2009 08:08 AM

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