So, what does the collective think about the new guidelines for detecting breast cancer?

I am concerned that it opens the door to insurance companies denying payment for mammograms to those who still wish to take a more proactive stance or who have high risk factors and wish to begin regular screening earlier.

I agree with dr pressman that it was such a small study and women should still go earlier and do self exams.

Like @syz I am concerned that insurance companies will no longer pay for annual mammograms while I’m still in my 40’s even though my GYN wants them. Although I’m not actually “high risk” she & I agree that if I should develop breast cancer, the earlier it is found & treated the better. Therefore I’m willing to risk possible “false positives” and have further testing to find that all is well rather than to have it growing silently without early detection. The surgery, chemo, radiation, & meds would cost the insurance company a lot more in later stages than a mammo, lumpectomy, and treatment when caught earlier.

I had to postpone a mammogram for three months due to a personal tragedy. The flilm picked up microcalcifications. A surgeon performed a lumpectomy, removed the cancerous breast tissue and 20 lymph nodes. The two sentinel ones were stage II.

I had chemo and radiation and took tamoxofin for five years. I consider myself one of the lucky ones. It;s been 14 years. Without the technology, I’d be dead because one cannot feel microcalcifactions by examining the breasts manually.

what would have happened if I had been able to get the mammo when scheduled? Would nothing have shown up on the films; or would I have been early enough to keep the cancer cells from traveling to the axillary lymph nodes?

@gailcalled May I ask if you were in your 40’s at the time? Just because the new guidelines change the mammos from a woman’s 40’s to her 50’s.

I think it’s ridiculous and could have dire consequences for women. Also, the fact that one article I read said self breast exams are basically pointless was just awful.

My mom’s mom died of breast cancer in her early 40’s. And I think these new “guidelines” are BS.

@LC_Beta I agree. I think we’re gambling with women’s health here. There was a woman on TV yesterday that made me so mad I almost turned the channel. I think these annual mammys are very important.

It makes no sense to me to suggest women wait longer for a first mammogram when breast cancer is one of the top 5 woman killers.

Do you think it is political at all? Some Republicans are making it sound like Liberals are happy about the guidelines.

I think part of the argument was that colonscopies and other cancer screening is suggested to start at 50, and that statistically there was little reason to suggest breast cancer was much different than these other cancers. That the marketing machine of breast cancer has convinced us to be more terrified and preoccupied with breast cancer than other illnesses, even ones that are more common like Heart disease.

I absolutely think it is ridiculous. Horribly ridiculous. Knowing more than one person who has suffered with Breast Cancer this scares me as well. I also agree with the point that this is just making our health care system even worse than it has to be. The insurance companies get away with so freaking much, this is just another thing they can get away with.

Is it political? Absolutely. It is no surprise that this issue is coming up at the same time as new health care reform suggestions.

So who made this determination about how it should start at 50 and what studies did they use to prove it should (perhaps I should go back and read the rest of the article, lol)? I think it needs to be re-examined by some neutral parties.

@RedPowerLady That link I gave is now asking to sign up, which it didn’t when I frist read it. From what I understand the government commissioned several different cancer institutions around the country to compile the stats and recommendations. Sloan Kettering, MD Anderson and others.

@JLeslie And all the cancer institutes came together and agreed on this recommendation? That is hard to believe. Were they being funded by some cause?

Thanks for the information. Just asking if you know the answers, not arguing or anything.

Here’s the American Cancer Society’s response:

American Cancer Society Responds to Changes to USPSTF Mammography Guidelines

I hadn’t realized that the new recommendation is for a woman at 50 to start getting mammograms every TWO years, not even annually!!!

Most of the woman I know that have or had breast cancer were diagnosed in their late 20s or 30s. :(

@BraveWarrior Thanks for the link.

@casheroo Did they have a family history? If they are under 40 they didn’t benefit from yearly screening for 40 and older anyway.

More screening ≠ better outcomes. Why not start at 30? 20? Puberty? There are risks to every screening test, along with major costs. As we need and try to address major health care issues (i.e. coverage for all), we will also have to deal with rationing of resources. Not all tests can be done, not all procedures can be performed, not everyone can be saved.

I never was going to comply with a mammogram every year from 40 anyway. But, I do need a colonoscopy every 5 years and my insurance won’t cover me 100% because I am so young, even though I have had a polyp. There is obviously something wrong with the system. We need to be allowed to taylor it more to the patients needs.

I don’t think it is right I am 22 and breast cancer runs in both my mothers and fathers side of the family. It skips a generation in my mothers side. So as far as I am concerned, I am at risk. I don’t think my health is something to be played with. I don’t think anybody should have to worry about not being covered. Yes there are people out there who are affected before the age of 40 and I think we should be covered no matter how old we are.

@JLeslie You’re welcome :)

My understanding from reading various articles is that if a woman is high risk (family history or genetic mutation), they would be a different story. The recommendation is for woman who are not high risk to have mammos every 2 years starting at age 50.

I also read that USPSTF guidelines are what insurance agencies often use for their policies.

The American Cancer Society states in the article I linked above ”“The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group. Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. The American Cancer Society feels that in both cases, the lifesaving benefits of screening outweigh any potential harms. Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early.
“With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.”

I agree with the American Cancer Society recommendation for annual mammograms for women ages 40–49 and for high-risk women younger than that. Then it should be decided between a woman and her doctor. In my opinion, a woman & her doctor should be able to make the decision based on the woman’s history, risk factors, and personal concerns, without having to worry whether or not the insurance company will pay for it.

Early detection gives a woman a fighting chance.

@shego I agree, someone like you should be covered even from the age of 30 in my opinion. But with some insurance companies even with the 40 recommendation, your insurance doesn’t cover you before 40. That is how my insurance works now. If I find a lump at any age I am not 100% covered for a mammogram, even if I am 60, because it is considered “diagnostic” I am only covered for regularly scheduled annual mammograms—it is unethical to me. My previous insurance would have covered it.

Please forgive my very cynical response.

When I first heard this news story I thought “Who did the insurance companies pay off?”

It is insanity. Mammograms save lives. I guess not enough lives in the 40–50 range to justify the costs. wow

@BraveWarrior Looking at your stats, do you know how that gels with the stat that 1 in 9 women get breast cancer?

@Dog Seriously. They waste money on this sort of thing, and not actually helping people :(

@JLeslie Looking at my stats? Do you mean the quote I took from the American Cancer Society? I can only suggest you read their article at American Cancer Society Responds to Changes to USPSTF Mammography Guidelines

I certainly would be outraged that your insurance company would not pay 100% for a mammo at any age if you discovered a lump! I think that’s awful!

@BraveWarrior Yes, I meant the article. I’ll have to look into the numbers more, I was just trying to make some sense of the different stats. I think it is awful to. As soon as something is deemed “diagnostic” rather than routine they don’t cover 100%!! In my mind more important to diagnose the person who is actually more likely to be sick! I would think it saves the insurance company money in the long run, so I just don’t get it? This is why I think the schtick about preventative care is such BS!! I hate the insurance companies. Their goal is profit not health care.

I think all, with strong opinions formed from even good press accounts should read the original article in the current issue of Annals of Internal Medicine

Personally I think it is fine example of ‘evidence-based’ medicine, albeit controversial.
It will take but a short time for all ‘vested’ interests to garner their rebuttal(s). The article’s result is a major sting against really big pieces of the cancer business: Surgery, Radiology, Oncology.

I wonder how they decided to come up with the intial suggestion of a mammogram every year after the age of 40? I have a feeling if the original recommendation had been 50 and older, we would not be up in arms. I am suspicious of all of it, who is in bed with who. Not suspicious of the science, but suspicious of why a certain suggestion is finally made and accepted.

I am a 33yr old woman whose mother has had breast cancer twice. The first time she was 36 and the second time she was 52. I started having mammograms right after my 30th birthday and have already had one breast biopsy. I spent several years working for a surgical group that specialized in diagnosing and surgically treating women with breast cancer and I saw a good number of women in their 30s and 40s developing breast cancer many without a family history. So I want to know where they got their data from and what kind of women they looked at. There is a genetic test for those with a family history but it is quite expensive and is upwards of $4,000. I don’t agree with their conclusions. As one woman mentioned you don’t find calcifications which can lead to breast cancer by doing a breast exam. This is a disease that can sneak up on women and can be spread through the lymphatic system so instead of just breast cancer it could also be in other major body systems.

@JLeslie That is why I posted the link to the original scientific paper. Read it, please. It is not a casual piece of work by lazy, misdirected physicians.

@BraveWarrior: I was 59 at the time of the diagnosis. No false alarms or alarms of any kind before that.

MY mother had a partial mastectomy when she was in her early 80’s. The age stats. seem meaningless next to the stories that women tell about their experiences.

@virtualist I am not able to find the specific article with your link? It did not go straight to the article you mention and when I tried to search I did not come up with it. Just wanted to point out, I said I believe the science is probably good, I did not call anyone lazy, and I think that people who are upset maybe should question how upset they are, because many are wanting to keep a standard or recommendation they are accustomed to, rather than listen to the science and possibly acknowledge that we accept these standards with other cancers. I am not one of the people very angry about the change in recommendation. When it comes to health care I am angry at insurance companies in general for other things.

Until the scientists get their act together, it makes little sense not to go along with the old guidelines. Cancer is too dangerous to be careless (as I was: twice. I may not be lucky a third time).

Not every woman or every family gets cancer. No one in my entire bloodline has ever had cancer. For my family heart disease is the main cause of death.

If it runs in your family, wouldn’t you just get a mammogram as needed? Wouldn’t common-sense tell you to be your own health advocate?

@SpatzieLover Yes, if your insurance would cover it or you could afford it. : (

@Dog Most peoples insurance covers anything recommended by their family/primary doc already. That goes without saying.

Personally, I think people are losing their minds with the whole “socialized medicine” argument. Is medicine better or worse compared to 50 yrs ago? How about compared to 10yrs ago?

@SpatzieLover I do think for the most part it is true though and am sorry if I seem a bit bitter or jaded. I have had unfortunate dealings with a family friend and her insurance. Which is unrelated to this topic and I apologize.

Kathleen Sebelius anounced today that they are not changing the recommendations according to a CNN headline I just read. Correct me if I’m wrong.

@janbb I don’t think the guidelines will be changed anytime soon. This was just a recommendation by one organization, not a change.

@Dog no sorry needed. Many insurance companies are great…the bad ones ruin the reputation for them

@JLeslie you asked how they came up with the original recommendation for annual ammograms beginning at 40yo. The American Cancer Society has recommended annual mammograms beginning at 40 since 1997. The National Cancer Institute for a long time recommended every 2 years for women in their 40s rather than annually. I can also tell you that Medicare pays for mammogram every other year, not annually.

Regarding monthly self breast exam, large well designed studies were done in China and Russia, including more than 300,000 women comparing self exam to no screening. They found no decrease in mortality from breast cancer in the women who did self exam. The main difference in the 2 groups was the women who were taught self exam were nearly twice as likely to have a biopsy for lump, most of them false positives. Even the American Cancer Society backed off their championing of monthly self exam once those studies came out acknowledging breast “self awareness” as a reasonable alternative. But old habits and ways of thinking die hard.

One of my biggest issues with the emphasis on regular self exam is that, realistically, most women don’t do it monthly. It’s just one more thing to feel guilty about. And I don’t like the idea of blaming the victim, because you can bet that when a woman is diagnosed with breast cancer, she is thinking back looking for what could have/should have happened differently, whether it’s having the last mammogram a few months earlier to checking her breasts compulsively.

@MagsRags Thank you. Very informative.

I just saw Larry King do a show on the Breast Cancer guidelines and everyone agreed from both sides that it is important for women to know their breast, and that especially in the age group below the age of 50 a significant percentage of women are they themselves the ones who first notice a change and bring themselves into the doctor only to find out it is cancer (I think they said 30% of cancers are found this way in that age group, but I am not sure I remember that percentage correctly, that is high to me, and seems neglegent to me that this is not being brought out through other media outlets. They further clarified that when they say they longer are recommending self exam, they mean the strict rules of once a month in the shower with a particular technique. They still think it very affective for women to be familiar with their own body.

@All: Read Gail Collin’s column in today’s NYT.

The Breast Brouhaha

@gailcalled That is what they were talking about on Larry King, that women find lumps watching tv or whenever, not necessarily in the shower once a month with their arm in a particular position at a certain time of the month. Probably most women never did that once a month thing religiously anyway. Thanks for the article.

The media has really sucked in getting the correct message out regarding self exam.

And don’t forget that many lovers and husbands discover lumps in their wife’s, partner’s, or SO’s breasts. I feel myself up with soap in the shower every so often. The soap makes the definition clearer.

I had mentioned previously that I am in my early 30s and have already had a biopsy. I had my mammogram 2 weeks before and it came up clean. Then a week and a half later i noticed there was an area that was painful and there was this hard pea like lump that had never been there before and it was painful to the touch. I have what are called nodular breasts and they feel like there are lumps but I have been taught what is normal and what isn’t. with a mom that has had breast cancer twice I do check on a regular basis.

@madsmom1030 When I was 18 or 19 my doctor found a hard “pea.” in my left breakfast. I did go for a second opinion, but everyone agreed it was just a cyst and just to be aware of it. It dissappeared after a few months. I never had an xray or a biopsy. I wonder if I was dismissed because I was so young, or if tumours are generally not perfectly round like that or what?

A girlfiend of mine recently went for her yearly exam and the doctor found domethng and ordered a mamogram, she is 41, and then they said they needed an ultrasound, because probably they saw nothing (by the way all of my friends who have had mammograms all had to have ultrasounds also) and the ultrsound tech asked her where the “lump” is, and she had no idea. The doctor never showed her what he felt. I think that is awful. She should be able to monitor the suspicious area.

You are correct about the dismissing part- most tumors aren’t perfectly round like a pea but have irregular borders. i usually have an ultrasound after my mammogram also.

On the occasional visits when my oncologist felt a cyst or cyst-like object, he always placed my finger on the spot. I had one aspirated at an office visit, and it simply collapsed. Better safe than sorry.

We, as patients, have to remember to ask the right questions. I suggest starting with, “Please show me.” And not just with breast lump issues. I insist that I am a 50% partner with my doctors in my diagnoses, treatments, meds, vitamins, blood work, etc.

Thanks @gailcalled for sending me a message that I wrote breakfast instead of breast above LOL! Too late to correct it.

Hmmm. Breast and breakfast. Where’s the connection there? ;-)

@shilolo Hahaha. I have no idea really. That was a suprising mistake. I really need to go back and edit better before I hit answer.

@BraveWarrior Great link. I didn’t think the Cancer Association would support the change. ps sorry late in discussion, having computer “issues”.