St. John’s Mercy Will Continue to Recommend Screening Mammograms

In response to guidelines published on Nov. 16 by the U.S. Preventive Services Task Force that you probably heard about in the news media, experts with St. John’s Mercy and St. Louis Cancer & Breast Institute want to assure women that annual mammograms remain the best way to detect early breast cancer. “The benefits of annual mammography have been extensively studied for more than 40 years, proving the effectiveness of annual mammography in reducing breast cancer mortality, both worldwide and in the United States,” said Dr. Kerri Dias, radiologist and associate director of St. John’s Mercy Breast Center.

Dias points out that while mammography is not a perfect tool, it does detect the vast majority of breast cancers. St. John’s Mercy agrees with recommendations from the American Cancer Society that it is in the best of interest of all women to get annual mammograms starting at age 40, and perform monthly self breast exams. For more information, contact the St. John’s Mercy Breast Center, 314-251-6300.

Editorial:

By Kerri Dias, M.D, Radiologist and Associate Director of St. John’s Mercy Breast Center.

This week the U.S Preventative Services Task Force presented new recommendations about annual mammography including:

• Screening mammography should not be performed routinely for all women ages 40-49
• Women aged 50-74 years should have mammography every two years
• There is insufficient evidence to recommend for or against screening mammography after age 74
• Self breast exams should not be taught nor performed.

These recommendations have caused significant debate in the medical community. More importantly, the public is confused about when to begin screening mammography. One fact that is not debated is: MAMMOGRAMS SAVE LIVES. Although mammography is not a perfect tool, it is the best method that we have to detect breast cancer.

Since the 1990 recommendation to begin annual screening mammography at age 40, breast cancer mortality has decreased 30 percent. However, breast cancer remains the second leading cause of cancer death among women. In 2009, women have less than 1 in 8 chances of developing breast cancer during their lifetime, and a 1 in 35 chance of dying from breast cancer. This year, over 192,000 new cases of invasive breast cancer are expected and more than 40,000 breast cancer deaths. Mammography is the best weapon we currently have to reduce these deaths.

The task force set out to evaluate risks and benefits of breast cancer screening. In science, it is mandatory to continually reassess current recommendations. However, there are concerns over research methods utilized by the task force. They reviewed a relatively narrow scope of articles. They did not include substantial literature from Sweden and the Netherlands that demonstrate the effectiveness of screening mammography. They also only evaluated articles that considered breast cancer death as an endpoint. To determine mortality rates, the task force used their own computer models that had never been peer reviewed.

In evaluating mortality rates, the task force says that 1,904 women ages 40-49 will have to be screened to save one life. But only 1,339 women ages 50-59 will have to be screened to save one life. These numbers can be debated. But I assure you that if you are one of the women whose life was saved, you would think that the screening was well worth any inconvenience.

The task force does mention that women who are at high risk for breast cancer may benefit from additional screening. While this is true, it is important to realize that approximately 75 percent of breast cancers do not occur in women who have a family history or genetic predisposition.

The task force then examined harms of mammography including discomfort, anxiety over positive results and possibility of over treatment. They did not consider studies that show women prefer to be called back for an abnormal mammogram or even have a biopsy that turns out to be cancer free. This way they know have done everything possible to prevent early breast cancer. The task force also failed to evaluate physical and emotional effects of breast cancer that is not detected until a later stage, including increased mastectomy rates and more aggressive therapy.

Finally, the task force recommended against monthly self exams. It is my opinion that women are their own best advocates. Every woman should know her own breasts, and immediately alert her physician if there is a change or a lump. Self exams are sometimes the first sign of breast cancer.

In conclusion, I strongly recommend yearly mammography beginning at age 40. The American Cancer Society, American College of Radiology, and Society of Breast Imaging have reached the same conclusion. Medicare is required by law to cover an annual screening for woman age 40 and older. Health and Human Services Secretary Kathleen Sebelius said that "although task force experts are government appointed, they do not set federal policy and they do not determine what services are covered by the federal government. I would be surprised if any private insurance company changed it's mammography coverage."

Mammograms save lives. I will be getting mine, and encouraging my patients to do so. I hope you will too.