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Dr. Lisa Sarber, whose cancer was discovered at age 48, |
BY JIM HALL
Dr. Lisa Sarber's breast cancer was discovered through a routine mammogram at age 48.
So the Fredericksburg internist was upset last week when she heard that a federal advisory panel had recommended that most women delay routine mammography until age 50.
"If we followed those recommendations, I'd probably be dead now," Sarber said.
Sarber was not alone among Fredericksburg doctors in questioning Monday's recommendation by the U.S. Preventive Services Task Force.
Five others doctors interviewed after the release of the panel's report said they were puzzled, even angered, by the findings, and would continue to recommend that their patients begin annual breast screenings at age 40.
"I'm sticking with the current recommendations," said Dr. D. Kay Blanchard, a Fredericksburg surgeon and breast cancer specialist. "It would be a real crime to wait until age 50 to start these screening mammograms."
Dr. Lea Shorter, a Stafford County obstetrician/gynecologist, described the panel's proposal as "infuriating." Asked if she would continue to recommend earlier testing, Shorter replied, "Absolutely."
SCARY BUT BENEFICIAL
Doctors said they are reluctant to accept the panel's recommendations because they've treated women like Sarber who benefited from early screening.
Sarber said she felt fine, with no noticeable breast lumps, when she went for her annual mammogram three years ago. However, the image had tiny specks on it.
"It looked to me like somebody had sprinkled glitter on my X-ray," she said.
Sarber went for more testing and discovered that she had breast cancer. Surgery, chemotherapy and radiation followed. Since then she has done well.
"They caught it very early," she said. "I have a good chance of being cured and never seeing this again."
The task force acknowledged the benefits of routine mammography for women 40 to 49, including a 15 percent reduction in mortality.
Yet when thousands of women are studied, the benefits do not outweigh the harm, the group concluded.
"Mammography screening at any age is a tradeoff of a continuum of benefits and harms," the panel said.
Those risks include the unnecessary testing of people who later learn that they don't have cancer, and the pain and anxiety caused by those extra procedures.
For example, if a woman's mammogram reveals an abnormal area in her breast, she might have a second mammogram and perhaps a biopsy to examine the suspicious tissue.
During this testing, she is "emotionally wrought," especially if there is a history of cancer in her family, said Dr. Donald Allen, medical director at the Imaging Center for Women, a Fredericksburg radiology service.
"Her immediate assumption is, 'Mine is going to be cancer, too,'" Allen said.
However, about 75 percent of biopsies are negative, Allen said. And for those women, anxiety soon turns to relief.
Still, Allen and other doctors point to the other 25 percent of women, those who have cancer, and especially those who learn it early when the cancer is more treatable.
Last year, radiologists in his practice diagnosed breast cancer in 62 women under the age of 50, he said. Another 60 women under 50 were found to have premalignant lesions.
"This has been a very effective program, and I'd hate to see it turned on its head," Allen said.
ONE PATIENT AT A TIME
One reason that doctors have reacted strongly to the task force's recommendations is that they look at the issue in a different way, said Dr. James Daniel, a Fredericksburg surgical oncologist and medical director of Oncology Resource Services at Mary Washington Hospital.
The task force had a "macro" point of view, concentrating on statistically significant samples of people, he said.
"I look at it as one patient at a time and have absolutely no trouble with screening 40-year-old women. None," Daniel said.
Robin Smigelski, a Stafford County resident, counts herself among those who benefited from early screening.
She was 42 when she went for her first mammogram. The test revealed a cancerous tumor, which was treated with surgery and radiation. She has been cancer-free for more than seven years.
Smigelski said she was upset this week when she heard about the panel's recommendation. She turned 50 in September. If she had waited until now for a mammogram, her prospects would not be as good.
"I'm not happy about this," she said. "I think it's a big step backward."
Jim Hall: 540/374-5433
Email: jhall@freelancestar.com
| The U.S. Preventive Services Task Force is about 25 years old and is a part of the U.S. Department of Health & Human Services. It consists of private-sector doctors and scientists who specialize in primary-care medicine.
The panel's job is to look at the available evidence and to say whether screenings and preventive medicines are effective and should be incorporated into routine medical care. Last Monday the task force changed its 7-year-old recommendation for screening mammography. It recommended against routine mammograms for women 40 to 49. The panel allowed for exceptions in individual cases, but said that regular mammography for most women can begin at 50. Groups such as the American Cancer Society, the American Congress of Obstetricians and Gynecologists and the American Society of Breast Surgeons opposed the change. And last Wednesday, Kathleen Sebelius, secretary of health and human services, repudiated her own panel. "They do not set federal policy and they don't determine what services are covered by the federal government," Sebelius said. "Our policies remain unchanged." To American women, she said: "Keep doing what you have been doing for years--talk to your doctor about your individual history, ask questions and make the decision that is right for you." --Jim Hall |
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"I have seen too many women in their 40s that have breast cancer that's been diagnosed with mammograms." --Dr. Kay Blanchard, surgeon"I find this [recommendation] puzzling, frightening and potentially misleading. Most clinicians have found cancer in women in their 40s." --Dr. Thomas Tomzak, obstetrician/gynecologist"Patients tell me that a mammogram hurts. Trust me. Chemotherapy and radiation hurt a lot worse than a mammogram." --Dr. Lisa Sarber, internist"We've decreased mortality rates by 30 percent with these screenings. We're finding a lot of cancers at a much earlier stage." --Dr. Donald Allen, radiologist |
