November 16, 2009New advice: Skip mammograms in 40s, start at 50
Stephanie Nano And Marilynn Marchione
Most women don't need a mammogram in their 40s and should get one every two years starting at 50, a government task force said Monday. It's a major reversal that conflicts with the American Cancer Society's long-standing position.
Also, the task force said breast self-exams do no good and women shouldn't be taught to do them.
For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.
But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women's odds of survival.
"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chair of the panel.
The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.
But Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group, said insurance coverage isn't likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.
Experts expect the task force revisions to be hotly debated, and to cause confusion for women and their doctors.
"Our concern is that as a result of that confusion, women may elect not to get screened at all. And that, to me, would be a serious problem," said Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer.
The guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations that would justify having mammograms sooner or more often.
The new advice says:
_Most women in their 40s should not routinely get mammograms.
_Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)
_The value of breast exams by doctors is unknown. And breast self-exams are of no value.
Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years because of scant evidence of their effectiveness. Decades ago, the practice was so heavily promoted that organizations distributed cards that could be hung in the shower demonstrating the circular motion women should use to feel for lumps in their breasts.
The guidelines and research supporting them were released Monday and are being published in Tuesday's issue of the Annals of Internal Medicine.
The new advice was sharply challenged by the cancer society.
"This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.
The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.
That stance "is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," he said. The cancer society feels the benefits outweigh the harms for women in both groups.
International guidelines also call for screening to start at age 50; the World Health Organization recommends the test every two years, Britain says every three years.
Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.
Mammograms can find cancer early, and two-thirds of women over 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated.
In most women, tumors are slow-growing, and that likelihood increases with age. So there is little risk by extending the time between mammograms, some researchers say. Even for the minority of women with aggressive, fast-growing tumors, annual screening will make little difference in survival odds.
The new guidelines balance these risks and benefits, scientists say.
The probability of dying of breast cancer after age 40 is 3 percent, they calculate. Getting a mammogram every other year from ages 50 to 69 lowers that risk by about 16 percent.
"It's an average of five lives saved per thousand women screened," said Georgetown University researcher Dr. Jeanne Mandelblatt.
Starting at age 40 would prevent one additional death but also lead to 470 false alarms for every 1,000 women screened. Continuing mammograms through age 79 prevents three additional deaths but raises the number of women treated for breast cancers that would not threaten their lives.
"You save more lives because breast cancer is more common, but you diagnose tumors in women who were destined to die of something else. The overdiagnosis increases in older women," Mandelblatt said.
She led six teams around the world who used federal data on cancer and mammography to develop mathematical models of what would happen if women were screened at different ages and time intervals. Their conclusions helped shape the new guidelines.
Several medical groups say they are sticking to their guidelines that call for routine screening starting at 40.
"Screening isn't perfect. But it's the best thing we have. And it works," said Dr. Carol Lee, a spokeswoman for the American College of Radiology. She suggested that cutting health care costs may have played a role in the decision, but Petitti said the task force does not consider cost or insurance in its review.
The American College of Obstetricians and Gynecologists also has qualms. The organization's Dr. Hal Lawrence said there is still significant benefit to women in their 40s, adding: "We think that women deserve that benefit."
But Dr. Amy Abernethy of the Duke Comprehensive Cancer Center agreed with the task force's changes.
"Overall, I think it really took courage for them to do this," she said. "It does ask us as doctors to change what we do and how we communicate with patients. That's no small undertaking."
Abernethy, who is 41, said she got her first mammogram the day after her 40th birthday, even though she wasn't convinced it was needed. Now she doesn't plan to have another mammogram until she is 50.
Barbara Brenner, executive director of the San Francisco-based Breast Cancer Action, said the group was "thrilled" with the revisions. The advocacy group doesn't support screening before menopause, and will be changing its suggested interval from yearly to every two years, she said.
Mammograms, like all medical interventions, have risks and benefits, she said.
"Women are entitled to know what they are and to make their best decisions," she said. "These guidelines will help that conversation."
__________________ "We can judge the heart of a man by his treatment of animals." ~Immanual Kant~
Now age 74, I haven't had a mammogram for over 17 yrs. No cancers in my family
history except for one uncle who had stomach cancer. Plus, I breast fed all 4 of my
children.
However I do believe in self-examination especially for women with family histories
of breast cancer. From age 20 on up, at least once a week.
__________________
May you always have..Love to Share, Health to Spare, and Friends that Care!
Vitamin D Prevents Cancer: Is It True?
I think the evidence that mammograms do more harm than good is incontrovertible. There are far too many false positives and far too many women are having excessively gross and severe treatment for misdiagnosed potential cancers that would not have been aggressive and which would incontrovertibly simply have disappeared when those women's vitamin d status increased to the level that the body could deal with the cancer naturally.
The cost of staying above 55ng/ml 137.5nmol/l is a mere $15 @ �10 annually. Code WAB666 $5 discount it seems totally unacceptable to me that screening is regarded as a part of a prevention program when it is merely a business promotion opportunity for those with a vested interest in profiting from cancer to provide unnecessary treatments that will forever change a women's health prospects.
The first priority for anyone worried about the potential for cancer is to raise vitamin D status to above 55ng/ml 137.5nmol/l with around 5000iu/daily/D3.
Boy, is this New advice on mammograms ever causing a Flap; lots of angry
women who are breast cancer survivors age 40 and younger. Some are
calling it Obamanomics! Just a glimpse of things to come in Health Care if
run by the Government.
__________________
May you always have..Love to Share, Health to Spare, and Friends that Care!
Boy, is this New advice on mammograms ever causing a Flap; lots of angry
women who are breast cancer survivors age 40 and younger.
Trouble is most people don't think for themselves and are very easily conned by unscrupulous business people. The whole business of screening is to maintain the supply of people for cancer treatments.
The fact is that the more often people are screened the more likely they are to get cancer or to have what could possibly be interpreted as coming under the definition of a potential cancer. Either way there is money to be made and who really cares if 9 women suffer mastectomy or chemo to theoretically save one one life.
Quote:
Some are
calling it Obamanomics! Just a glimpse of things to come in Health Care if
run by the Government.
The sooner people realize neither the state nor insurance companies can afford the current state of medicating everyone from before birth through to death the better.
Life is for living and not being treated as a target for daily medication or medical treatment.
Fortunately natural medicine such as eating those foods our DNA evolved to recognize as food and by ensuring we have a NATURAL vitamin D, omega 3, selenium, iodine and magnesium status will help improve our immune function and avoid many of the common diseases of civilization.
The whole business of screening is to maintain the supply of people for cancer treatments.
The fact is that the more often people are screened the more likely they are to get cancer or to have what could possibly be interpreted as coming under the definition of a potential cancer.
Life is for living and not being treated as a target for daily medication or medical treatment.
Ted, I respect your opinion and input in these matters, thanks.
What is your take on colonoscopies? I've never had one, and don't intend to get one. Someone I know, who started getting them at the age of 50, began with negative outcomes, but now has colon cancer. Part of his colon was removed, and the cancer has spread to other parts of his body, including his liver This fellow was healthy all his life, ate very little meat/sweets, did not drink or smoke, etc., etc.
__________________ "We can judge the heart of a man by his treatment of animals." ~Immanual Kant~
Breast Cancer Saliva Test to Make Dangerous Mammograms Obsolete
by David Gutierrez, staff writer
(NaturalNews) Researchers are working to develop a saliva test for breast cancer that could vastly reduce the use of dangerous and invasive breast cancer screening techniques such as mammograms.
"This will be a noninvasive, quick means of detection," said lead researcher Charles Streckfus, a professor of diagnostic sciences at the Dental Branch of the University of Texas (UT) at Houston. "With it, dentists will be able to catch cancers before a woman can feel a lump."
Researchers have discovered that the onset of breast cancer changes the density of different proteins excreted by the salivary glands. In the current study, published in the journal Cancer Investigation, Streckfus and other researchers from the UT-Houston Dental Branch and Medical School compared the protein levels found in the saliva of 10 women with breast cancer, 10 healthy women and 10 women with a type of tumor called fibroadenoma.
Fibroadenoma is the most common kind of benign breast tumor.
"Saliva is a complex mixture of proteins," said researcher William Dubinsky. "We go through a process that compares different samples by chemically labeling them in such a way that we can not only identify the protein, but determine how much of it is in each sample. This allows us to compare the levels of 150-200 different proteins in cancerous versus non-cancerous specimens to identify possible markers for disease."
The researchers identified 49 proteins that were present at different levels between the three groups. These proteins should hypothetically allow doctors to use such a saliva test to alert them when a woman has a tumor, and to determine whether it is cancerous or benign.
"This is a unique finding," Streckfus said, "as it targets both the benign and malignant tumor, which could potentially reduce the number of false positives and false negatives associated with current cancer diagnostics".
Previously, the same team of researchers was able to correctly detect whether a woman had breast cancer 85 percent of the time, using only one saliva protein as a marker. With 49 different markers, Streckfus says that the accuracy of the test should be closer to 95 percent.
In the current method, the saliva sample is placed onto a hand-held, gold-plated chip or lab dish, developed by UT-Austin biochemists. A laser analyzes the protein content of the sample.
"I see this as a future public health service by dentists," Streckfus said. "Most folks, especially women and children, visit the dental office way more often than they ever see the physician. Saliva is a non-invasive, quicker way for detection."
Many obstacles remain before this test could be available, however. The first step is more studies to confirm the effectiveness of the protein markers as diagnostic tools in a larger group of patients. Streckfus and colleagues hope to launch a large, multicenter clinical trial of the test within the next two years, and to apply for FDA approval within five.
The only saliva test currently approved by the FDA is one for HIV/AIDS.
A saliva test for breast cancer has many advantages over current diagnostic methods such as ultrasounds, mammograms, biopsies and blood tests. It would be far less invasive and expensive than most such tests, and have a much higher accuracy rate than blood tests, which are not currently favored for breast cancer diagnosis due to their poor accuracy.
The higher accuracy of a saliva test comes in part from the fact that saliva proteins are much easier to detect than the proteins in blood, Dubinsky said.
"In the case of breast cancer, saliva analysis has been used to monitor patient response to chemotherapy or surgical treatment of the disease," said Professor Damien Walmsley, scientific adviser for the British Dental Association. "The mouth itself is a good indicator of an individual's overall health, and dentists already play an important role in diagnosing and detecting oral cancers."
Streckfus said that a saliva test would be particularly valuable in places where mammography centers are rare, such as in many Third World countries, or in breast cancer survivors who need to be regularly monitored for potential cancer recurrence.
Regular use of mammograms is not only expensive and emotionally distressing, but can also be dangerous. Because women are exposed to X-ray radiation as part of the mammogram procedure, regular mammogram use actually increases women's risk of developing various cancers. For this reason, mammograms are not normally performed for women under the age of 40, in whom the risk of breast cancer is relatively low unless symptoms are present.
But Streckfus warned that a saliva test cannot utterly replace mammograms, because the saliva test is unable to determine which breast contains the tumor.
Nonetheless, cancer patient advocates have greeted the new research as promising. According to Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society, the saliva test will one day be "a terrific advance."
"I think advances like this test portend the day when we'll be able to diagnose disease that would be invisible using today's technologies," Lichtenfeld said. "[Patients will] be able to be diagnosed and treated before they would otherwise know they have the disease."
Streckfus and colleagues are also researching whether saliva tests can be used to diagnose other cancers, including of the cervix, uterus, head, neck and ovaries. Another group of researchers, at Johns Hopkins Kimmel Cancer Center, is also working on a saliva test for head-and-neck cancer. According to Lichtenfeld, the Johns Hopkins team is farther along than the UT-Houston team, because their test relies on genetic rather than protein markers.
__________________ "We can judge the heart of a man by his treatment of animals." ~Immanual Kant~
Mammograms "New Advice"
Mammograms!
Vitamin D Prevents Cancer: Is It True?
This fellow was healthy all his life, ate very little meat/sweets, did not drink or smoke, etc., etc.
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