New Guidelines Renew Debate Over When To Start Mammograms

The radiologists who diagnose breast cancer every day in women's imaging centers across the nation have one primary goal: finding the cancer early enough to treat it before it spreads.

Their primary weapon in this battle is mammography. For years, women have been told to get a mammogram every year starting at age 40, a screening test covered by health insurance.

Now a government panel called the Preventative Services Task Force has come up with new draft recommendations telling women to wait until age 50 to have a mammogram, and even then, to only get one every other year.

"We feel that the adoption of the Preventative Services Task Force recommendations would result in thousands of additional breast cancer deaths per year," said Dr. Shari-Lynn Odzer, a radiologist with the Memorial Health Care System.

Dr. Odzer cited a 2011 study that estimated 6,500 more women would die from breast cancer every year in the United States if mammograms were not performed on the 40 to 49 age group.

Breast cancer survivor Cherise Metz is a case in point. She thinks the task force recommendation is a huge mistake

"Well I think it's very scary, I was 46 when cancer was found in me as a result of a screening mammogram, and thank God," Metz said.

One of the biggest concerns in the medical community is the impact of the recommendations on insurance coverage. If the recommendations become official, there's a strong likelihood that private insurers will only cover mammograms for women over 50, and only every other year.

"We're concerned that this will encourage women to wait and not get a screening test that could potentially save their lives," Dr. Odzer said.

Florida Rep. Debbie Wasserman Schultz, herself a breast cancer survivor, released a statement Tuesday calling the recommendations "a dangerous step in the wrong direction.

"Women with significant genetic risk factors for breast cancer should not have to worry about whether their insurance will cover preventative screenings, which can catch cancers earlier and potentially save their lives," Wasserman Schultz said. "As a young breast cancer survivor who was unaware of my own increased risk before my diagnosis at 41, I strongly believe we need more, not less, preventive services available to patients who need them."

The recommendation acknowledges that screening mammograms reduce the chance of dying from cancer in the 40 to 49 age group, and says women in that age group should make their own choices about having one.

However, as Dr. Odzer points out, many women can't afford even a relatively inexpensive procedure like a mammogram, so if it's not covered, they won't have one, regardless of what their personal doctors say.

The task force says mammography in the 40 to 49 age group often leads to many, expensive procedures that turn out to be unneeded.

"I'd much rather have a false positive and have to go through a biopsy and have the biopsy come back negative than to discover too late that I had an invasive cancer," said Cherise Metz. "I actually had a couple of false biopsies before my positive biopsy that found my cancer, and I'm lucky enough that it was caught at such an early stage that I had options, and I'm thankful for that."

Doctors in the breast cancer community are also complaining that the task force included no breast cancer experts, and that it "cherry picked" data to use in its recommendations.

"The task force has seemed to limit its evidence review to studies that overestimate the impact of false positive rates and it has underestimated the life-saving benefit of screening mammography," said Dr. Odzer. "We believe, and evidence supports, that breast cancer detected early is a breast cancer more likely to be treated and cured."

(Full disclosure: Dr. Shari-Lynn Odzer is the wife of NBC6 reporter Ari Odzer.)

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