June 24, 2018
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Maine breast cancer survivors, doctors question starting mammograms at age 50

Bangor Daily News | BDN
Bangor Daily News | BDN
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. (Bangor Daily News/Kevin Bennett)
By Meg Haskell, BDN Staff

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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