If I'd Followed This Advice, I'd Be Dead.

[Buckalew11]

This is the 2nd time I have heard of this type thing being a new recommendation. I think we're being set up for less care--or harder to get care. This way we won't be upset when we can't get the test--because it is no longer recommnded for that age etc. I think it is a set up for how universal healthcare and how it'll work.

 

[Buckalew11]

I had to go to work and spend 2 hours with a bunch of oncology nurses....who cannot believe these recommendations! I hope it's okay to post this news report. The doctor quoted was my doctor who I saw after my first mammogram/biopsy/lumpectomy.

I want to wish those survivors who have posted continued good health and those dealing with this disease hope for a healthy future! We have come a long way in dealing with bc over the past decade.


Mayo: Don't skip the mammograms
11/17/2009 9:05:01 AM
Comments (25)
By Jeff Hansel

Post-Bulletin, Rochester MN

An independent government-appointed panel is challenging the current methods for breast cancer screening in women, citing evidence that the potential harm of having annual exams beginning at age 40 is greater than the benefit.


Mayo Clinic Key Messages

Mayo Clinic advice:

• Keep your appointments for breast screening and discuss any concerns with health providers.

• Be familiar with your breasts. If there are any changes, bring this to doctors' attention promptly.

• Women at high risk for breast cancer due to family history and/or genetic profile should follow health-team advice.

(Source: Mayo Clinic)

Old way:

• Mammograms every year starting at age 40

• Breast self exams recommended

Task force recommends:

• Mammograms every two years -- not starting until age 50 -- and continuing through age 74, except when a patient is at high risk (when screening would be done earlier). The choice of whether to start earlier than 50 "should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."


Mayo Clinic, though, plans to keep following American Cancer Society advice of women age 40 and older have annual mammography screening, said Dr. Sandhya Pruthi, director of the Mayo Breast Diagnostic Clinic.

"This is not going to affect our practice. However, it's going to have patients up in arms," Pruthi said.

Patty Allen, co-founder of Join the Journey, a Rochester non-profit organization that raises money for cancer education, support and awareness, was aghast at the report.

"To come out with a statement like that's a big, fat waste of time -- is just the dumbest thing I've ever heard, that's my take on it. You're just reversing years of public education," Allen said. "... if it's based on science, what can I say, except I think it confuses people." It's unclear what will happen with insurance and Medicare coverage.

But the U.S. Preventive Services Task Force in its report says "false positives, unnecessary biopsies, and overdiagnosis" are problems for women under 50. Also, a breast self exam "does not reduce breast cancer mortality," says a task force article posted online in the Annals of Internal Medicine, the journal of the American College of Physicians.

Mayo, however, said, "data from multiple long-term studies show that routine mammography screening for breast cancer, and subsequent treatment, lowers a woman's risk of dying from the disease by at least 20 percent, compared with women who do not get screened." Pruthi continues to educate and encourage patients to do breast self exams. Also, mammography before age 50 has been shown to decrease mortality, she said, which the journal article acknowledges despite its recommendations.

The journal article says "to extend one woman's life," 1,904 women age 40 to 49 would have to get screened, versus 1,339 to have the same effect between ages 50 and 59 (because breast cancer risk rises with age).

"I was 48 with no risk factors, no history -- nothing. I just went in for a routine mammogram every year ... they found a cancer," said Allen.

When was the last time Pruthi diagnosed a 40-something woman with breast cancer?

"Today -- I see it every day. My colleagues and I diagnose women every day in their 30s and 40s."


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Having had a personal experience at Rochester's Mayo Clinic, I have the utmost respect for them and their recommendations to the public. Thanks fpor posting this.

 

[Piecey]

I know a few women who were diagnosed after 50, but I know more who were diagnosed before.

My mom got breast cancer twice before she turned 40.

I think it's ridiculous.

I'm not sure what the recommendations are for myself, but I know it's way earlier than 50 because of my family history.

I've already had one and it showed abnormalities!

 

[DawnCt1]

I couldn't believe it when I read this report. How much influence does insurance have on this study? If I have to pay for them myself, I'll continue to mave mamo's. As for self exam..almost everyone I know who has had breast cancer, has found it during self exam, and the person who didn't, was 42 and it was found via mamo. Yes, there are lumps and bumps found during self exam that are nothing more than lumps and bumps..but that's what has often gotten woman to the doc..and while in most cases it's nothing, who wants to volunteer to be the person who doesn't exam, and finds out the self exam could have saved their live?

Prayerfully everything will be OK for your daughter C.Ann. It's good she was diligent in her exams, no matter which way it goes. Better to hear..'it's nothing' than to hear, 'why didn't you come in sooner'.

For all or you who have shared your stories..thank you. It just goes to show that we have to do what we as woman feel is in our best interests.

Apparently none for now! The front page of this morning's Hartford Courant said that "Insurers are sticking to the old breast exam rules". That doesn't mean physicians and patients aren't worried down the road however.

 

[DawnCt1]

This is the 2nd time I have heard of this type thing being a new recommendation. I think we're being set up for less care--or harder to get care. This way we won't be upset when we can't get the test--because it is no longer recommnded for that age etc. I think it is a set up for how universal healthcare and how it'll work.

EXACTLY! The dollar comes before healthcare. Most states test newborns for PKU. It is an inexpensive test, doesn't find many babies with the problem, in fact its rare. But a baby with unidentified phenylkeytonuria who isn't put on a special diet will suffer a devastating and ultimately fatal outcome. In actuality, the cost of the test doesn't justify testing every baby.....unless its your baby that's discovered. Then it is worth everything.
Thank God we make decisions in human terms and not just dollars. There is a huge difference between "worth" and "cost".

 

[OceanAnnie]

This is the 2nd time I have heard of this type thing being a new recommendation. I think we're being set up for less care--or harder to get care. This way we won't be upset when we can't get the test--because it is no longer recommnded for that age etc. I think it is a set up for how universal healthcare and how it'll work.

I think you are absolutely right. I hope there is a lot of outrage and backlash over this. I really do. It's unacceptable. Going backwards and costing lives.

EXACTLY! The dollar comes before healthcare. Most states test newborns for PKU. It is an inexpensive test, doesn't find many babies with the problem, in fact its rare. But a baby with unidentified phenylkeytonuria who isn't put on a special diet will suffer a devastating and ultimately fatal outcome. In actuality, the cost of the test doesn't justify testing every baby.....unless its your baby that's discovered. Then it is worth everything.
Thank God we make decisions in human terms and not just dollars. There is a huge difference between "worth" and "cost".

Isn't that the truth. I'm hoping that will not become a thing of the past.

 

[DancingBear]

EXACTLY! The dollar comes before healthcare. Most states test newborns for PKU. It is an inexpensive test, doesn't find many babies with the problem, in fact its rare. But a baby with unidentified phenylkeytonuria who isn't put on a special diet will suffer a devastating and ultimately fatal outcome. In actuality, the cost of the test doesn't justify testing every baby.....unless its your baby that's discovered. Then it is worth everything.
Thank God we make decisions in human terms and not just dollars. There is a huge difference between "worth" and "cost".

Once again, I point out that the panel's recommendation is not based on dollar costs.

 

[4nana]

Thank God you were proactive Peg, and thanks for reminder we can't be too careful when it concerns our bodies ! Thankfully my 80yo Mom is BC survivor, had a mastectomy at 65yo. Due to family history, our 3 DD's started their mammos between 35/40yo, in spite of recommendations! Continued best wishes!

 

[DawnCt1]

Once again, I point out that the panel's recommendation is not based on dollar costs.

They may not have used the word "cost" but its in there. Most experts have concluded that is the purpose and the intent of the study.

 

[DawnCt1]

I think you are absolutely right. I hope there is a lot of outrage and backlash over this. I really do. It's unacceptable. Going backwards and costing lives.



Isn't that the truth. I'm hoping that will not become a thing of the past.

My mother had a saying; "Some people know the price of everything and the value of nothing". They can deny that "cost" is an issue, but it is.

 

[DancingBear]

My mother had a saying; "Some people know the price of everything and the value of nothing". They can deny that "cost" is an issue, but it is.

They don't deny that "cost" is an issue, they're just not talking about dollar costs. They're recognizing that there is a human cost from the stress of false positives, unnecessary biopsies, etc.

A lot of the personal stories here are about women who discovered issues before the age of 40. Should we be attacking the American Cancer Society for not recommending mammograms for younger women? The ACS is also drawing a line when they make their recommendation, they're just drawing it in a different place.

 

[DancingBear]

They may not have used the word "cost" but its in there. Most experts have concluded that is the purpose and the intent of the study.

They certainly did use the word "cost" several times in the recommendation. Perhaps you should try reading it. They just aren't talking about dollar costs.

And please tell me about the methodology by which you determined that "Most experts have concluded that is the purpose and intent of the study."

 

[disney1990]

Heard this on the news and I honestly can't say I'm surprised. My insurance company doesn't even pay for an annual pap anymore

Medicare doesn't either -- only every other year. My BF paid for her own this year.

 

[mill4023]

Once again, I point out that the panel's recommendation is not based on dollar costs.

Saying something more than once doesn't make it true. You are either incredibly naive or you're just arguing for the sake of argument. I'm not sure which.

You really think the timing of this "recommendation" during a push for a government takeover of our healthcare system is coincidental? Give me a break. The recommendations of this panel will be used by the government to determine what is covered and what is not when we are all being insured through the government.

So yes, it is obviously about cost.

The money saved on millions of mammograms will more than pay for the small number of cancer cases that end up costing more because they weren't detected early.

 

[OceanAnnie]

Saying something more than once doesn't make it true. You are either incredibly naive or you're just arguing for the sake of argument. I'm not sure which.

You really think the timing of this "recommendation" during a push for a government takeover of our healthcare system is coincidental? Give me a break. The recommendations of this panel will be used by the government to determine what is covered and what is not when we are all being insured through the government.

So yes, it is obviously about cost.

The money saved on millions of mammograms will more than pay for the small number of cancer cases that end up costing more because they weren't detected early.

ITA. And the new recommendations are not to save women from the hearing false positives on mammograms either. These recommendations have nothing to do with humanity. Please.

 

[mill4023]

Actually, the same panel made a recommendation in August 2008 regarding prostate screening:
http://www.ahrq.gov/clinic/uspstf08/prostate/prostaters.htm

Yes, and from at least 2002 until now, this same panel also recommended that women begin getting mammograms at age 40.
http://www.ahrq.gov/clinic/3rduspstf/breastCancer/

Leaving aside the question of whether this panel is "the government," why do you believe that the National Cancer Society's recommendation is more valid than the panel's?

Because the NCS has oncologists.
Because none of the USPSTF members are oncologists.
Because the USPSTF is part of the same government that wants to take over our healthcare system and will have to reduce costs by whatever means necessary.
Because until now, when Obama is pushing for government healthcare and cutting medicare costs, the USPSTF had recommended mammograms starting at 40.

 

[DancingBear]

Because until now, when Obama is pushing for government healthcare and cutting medicare costs, the USPSTF had recommended mammograms starting at 40.

Aside from being aware that there is a prohibition against political postings on this website, are you aware that (1) 12 of the 16 members of the panel were seated during the George W. Bush administration, and the remaining 4 were chosen during the Bush presidency, (2) this panel is sponsored by, but does not represent the federal government, and (3) HHS Secretary Sebelius has issued a statement that the federal government's policy remains unchanged.

http://www.google.com/hostednews/afp/article/ALeqM5jdykF3qgAvzKe1YTDj3ttFFDYNVw

 

[DancingBear]

Yes, and from at least 2002 until now, this same panel also recommended that women begin getting mammograms at age 40.
http://www.ahrq.gov/clinic/3rduspstf/breastCancer/

Correct, and the panel's reasons for making the change are set forth in the recommendation:

Explanation of Change in Recommendation
The 2002 USPSTF issued a B recommendation for screening mammography for women 40 years or older. However, it went on to say:

The precise age at which the benefits from screening mammography justify the potential harms is a subjective judgment and should take into account patient preferences. Clinicians should inform women about the potential benefits (reduced chance of dying from breast cancer), potential harms (for example, false-positive results, unnecessary biopsies), and limitations of the test that apply to women their age. Clinicians should tell women that the balance of benefits and potential harms of mammography improves with increasing age for women between the ages of 40 and 70 (6).

The updated USPSTF recommendation endorses this approach to deciding when to start screening. However, the current USPSTF is now further informed by a new systematic review (7), which incorporates a new randomized, controlled trial that estimates the "number needed to invite for screening to extend one woman's life" as 1904 for women aged 40 to 49 years and 1339 for women aged 50 to 59 years. Although the relative risk reduction is nearly identical (15% and 14%) for these 2 age groups, the risk for breast cancer increases steeply with age starting at age 40 years. Thus, the absolute risk reduction from screening (as shown by the number needed to invite to screen) is greater for women aged 50 to 59 years than for those aged 40 to 49 years.

The current USPSTF statement is also informed by the Cancer Intervention and Surveillance Modeling Network (CISNET) modeling studies (8) that accompany this recommendation. The Task Force considered both "mortality" and "life-years gained" outcomes. In this case, given that the age groups (40 to 49 years and 50 to 59 years) are adjacent, the Task Force elected to emphasize the mortality outcomes from the modeling studies. Of the 8 screening strategies found most efficient, 6 start at age 50 years rather than age 40 years. The frontier curves for the mortality outcome show only small gains but larger numbers of mammograms required when screening is started at age 40 years versus age 50 years.

In conclusion, the USPSTF reasoned that the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age. This leads to the C recommendation. The USPSTF notes that a "C" grade is a recommendation against routine screening of women aged 40 to 49 years. The Task Force encourages individualized, informed decision making about when to start mammography screening.

Shouldn't the panel make changes when it deems appropriate based on additional science?

 

[DancingBear]

Saying something more than once doesn't make it true. You are either incredibly naive or you're just arguing for the sake of argument. I'm not sure which.

How about neither? How about acknowledging the possibility that the members of this panel are trying to do their best to make a scientifically-based recommendation. Again, they set forth in great detail the evidence they've reviewed and the reasoning for the recommendation, just as they have done for many years with regard to many issues.

Most if not all of the attacks made here against this panel really address directly the points made by the panel in their recommendation. Instead, we have attacks on their qualifications and unsupported allegations that they are motivated by saving money for insurance companies (although the reason they are funded by the government is to protect from such influences) or by saving money for the government or to promote the current administration's agent (although this panel does not speak for the government, was completed seated or selected by the current administration, and the current administration has distanced itself from the recommendations).

...The money saved on millions of mammograms will more than pay for the small number of cancer cases that end up costing more because they weren't detected early.

Do you have any actual facts to back this up? Because it seems to go against everything you ever hear about the dollar costs and benefits of good preventative care.

 

[mill4023]

Aside from being aware that there is a prohibition against political postings on this website, are you aware that (1) 12 of the 16 members of the panel were seated during the George W. Bush administration, and the remaining 4 were chosen during the Bush presidency, (2) this panel is sponsored by, but does not represent the federal government, and (3) HHS Secretary Sebelius has issued a statement that the federal government's policy remains unchanged.

http://www.google.com/hostednews/afp/article/ALeqM5jdykF3qgAvzKe1YTDj3ttFFDYNVw

So now mentioning the fact that Obama is pushing for government controlled healthcare is a political posting?
Sorry, I'm not following your logic here.

I don't see the relevance of when or how the members of this agency were put in place.