Sunday, November 22, 2009

What's with these cancer screening recommendations?

So this week was a busy week for women and cancer recommendations - and they came from very different sources. First was the mammogram controversy: a US government task force recommended against routine yearly mammograms for women under the age of 50, citing the facts that "only" 15% of women are diagnosed with breast cancer between the ages of 40 and 49, and that many others experience false positive mammograms which result in stress and extra tests (ie biopsies of lesions). The other part of this recommendation was that women get mammograms every 2 years rather than yearly. The biggest concern with these new recommendations is that private insurance will no longer fund routine mammograms for women in their 40's. The other concern is who made up this task force - according to CNN not a single physician on the board was an oncologist .....wait a sec..these people are making recommendations regarding CANCER and there is no oncologist's input??? How does that make any sense?

This frustrated me greatly - first what about those 15% of women who are diagnosed with breast cancer in their 40's? Because they fall outside of the "common" age of women with breast cancer, they are not included in these recommendations? I'm not sure I feel comfortable about that. Also, now that my mother was diagnosed with breast cancer (at the age of 56) her oncologist recommended that my sister and I begin routine mammograms at 40. Now it is very possible that I will have to pay for every single mammogram out of pocket until I reach 50. The other thing is breast cancer can be very aggressive - the difference between a normal mammogram one year and an abnormal mammogram 2 years later can be astounding. All this made me wonder what other countries recommend for mammograms, so I looked it up on Canada and England's national health websites.

Canada recommends mammograms every 2 years for women between 50 and 75. (They do recommend you get a second mammogram one year after an abnormal mammogram with other normal testing like a normal biopsy). In England they have what is called the NHS Breast Screening Programme which women over 50 must be invited to participate in. You get your first invitation after you turn 50, but they don't guarantee that you will be invited at that time - however you are assured an invitation by your 53rd birthday at the latest. They give free screenings every 3 years under this program until you reach the age of 70. By 2012 they plan on expanding the age limits to 47-73. According to their website they set their age limits based of ease of mammogram readability and the lower incidence of breast cancer in women younger than 50. In pre-menopausal women, breast tissue is much more dense and mammograms are not as reliable. Since the average age of menopause in England is 50, they set their recommendation at that age. They do, however, point out that with the advent of digital mammography, mammograms can be better performed and interpreted on those women with denser breasts.

So how do these practices correlate to death & survival rates? These numbers must be taken with a grain of salt because they represent different years and lengths of time but it's the best I could find. Here are the 5-year survival rates for breast cancer based on country:

US (cancers diagnosed between 1999-05) 89.1%
Canada (cancers diagnosed between 1996-98) 86%
England (cancers diagnosed between 2001-03) 80%

Makes you wonder why our country is leaning toward what these other countries are doing?

If you ask me (which no one is, but I'll give my 2 cents anyway) I think we should be doing more to expand access to breast cancer screening like clinical breast exams and mammograms to the US people rather than creating more restrictions. It is shown that survival rates vary among SES and race in the US, so the best way to increase survival is to increase access to those who women don't have it, rather than restricting those who do have access. Okay, I'll get off my soapbox for now.

I'll address the cervical cancer recommendations in another post at another time...too many stats for me for one day!

1 comment:

  1. A correction must be made to your post. My Doctor's recommendation is for you and Crystal to start mammograms 5 years before the norm, therefore age 35 not 40.