Mammography guidelines

Article re mammography guidelines in today’s Guelph Mercury newspaper by Vik Kirsch:
Long-term breast cancer survivor Lynn Roodbol couldn’t disagree more with a new panel’s conclusion that women don’t need mammograms in their 40s.

While living in British Columbia in the mid-1980s, Guelphite Roodbol, 64, found a lump.

“My doctor refused to give me a mammogram. He said I was too young to have breast cancer.” But her persistence paid off: she was ultimately diagnosed as having breast cancer — despite being only 41 at the time.

“That’s why I believe in mammography starting at 40,” said Roodbol, a member of the Guelph Wellington Breast Cancer Support Group who is — ironically — a Guelph and Kitchener mammographer by profession, recently retired.

There’s increasing public debate about a U.S. Preventive Services Task Force panel of experts concluding routine mammograms aren’t needed for women in their 40s. They found little evidence survival rates are better than for women tested in their 50s. Current American guidelines recommend screening every year or two for women in their 40s. But the task force noted a high number of false positive results for women in their 40s leading to unnecessary removal and sampling of tissue.

In the face of concern in the U.S. that the task force is attempting to cut costs for health care providers, President Barack Obama’s administration is assuring the public the government would continue to fund mammograms for women 40 and older, the New York Times reported last week.

The task force recommendations dovetail with what’s the norm in Canada: routine testing of women starting in their 50s.

Canadian Cancer Society senior manager of prevention Gillian Bromfield said periodic testing of women 50 to 69 years of age and of average risk “has been shown to save lives.”

Evidence it would benefit women in their 40s “hasn’t come to light.”

The exceptions include women in elevated risks, such as those in families with histories of breast cancer or those who have had previous exposure to radiation. Such women should have discussions with their doctors about when it’s appropriate to begin mammogram testing.

“They should start those discussions early,” Bromfield said, adding that could begin even before they’re in their 40s in some circumstances.

But Bromfield acknowledged there’s ongoing debate in the public about what’s best. Some people assume that if regular testing is beneficial to people in their 50s, it should be helpful at an earlier age. But among the issues is the fact women younger than 50 have denser breasts, so mammograms may not be as revealing. There are also more false positive test results in younger women.

But Roodbol says she’s living proof women can get breast cancer in their 40s and should be proactive.

By the time her cancer was confirmed, it was in the second stage of development, had grown to a significant size and spread to her lymph nodes. She underwent surgery, received whole-body chemotherapy and made lifestyle changes in exercise and diet.

Roodbol urged women in their 40s to have a healthy respect for the threat of breast cancer. If they have legitimate concerns, they should see their doctors about having mammograms as a precaution.

They shouldn’t wait until they’re 50, Roodbol concluded.

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