When it comes to mammography, you and your doctor always know best

New guidelines from a government task force that recommend most women wait until 50 to begin routine mammograms have fueled the health care debate this week.

The Preventive Services Task Force of the Department of Health and Human Services also downplayed the effectiveness of breast self-exams and advised that women ages 50-74 receive mammograms every other year.

The recommendations are a big swing from what the American Cancer Society has advised for two decades – that women age 40 and older should receive annual mammograms and should perform regular self-checks.

But the task force, a panel of scientists and doctors, concluded that having screenings that early and frequently often leads to false alarms and unneeded biopsies, without substantially improving women’s odds of survival. They say there is no need for women to be alarmed about the recommended changes for screenings.

U.S. Rep. Phil Roe, R-Johnson City, Tenn., a retired obstetrician who now represents the First District in Tennessee, is alarmed by the recommended changes. He appeared on Fox News earlier this week and called the recommendation a 180 degree turn away from efforts made to educate women about the importance of early detection. He also said some of the most aggressive cancers are found in younger patients.

In a Thursday interview with this newspaper, Roe said survival rates for breast cancer were about 50 percent in the late 1970s when he began practicing medicine. Today, thanks to improved physician training, self exams, mammography and educating patients, the survival rate has improved to more than 90 percent, he said.

Roe said having a solid relationship with their doctor is key to women’s health.

We agree. Regardless of government guidelines, old or new, women need to educate themselves, know their bodies and talk to their doctors about their concerns or questions.

He said he used “Roe’s Rule” in his practice – he encouraged patients to listen to their instincts and press him to re-examine them if they had any lingering concerns.

“I am not perfect and if you feel something, call back and I will look again,” Roe said. “How bad would it be if I told you, you don’t have anything?”

Women also need to learn more about breast cancer – such as the fact that family history doubles your risk and is something you must tell your doctor to determine a proper screening schedule. Or that obesity is a risk factor for breast cancer. Or that one in nine women will develop breast cancer.

The bottom line? Recommendations are a framework, but the best way to make medical decisions is with a medical professional. We recognize that mammography is an integral tool to help diagnose breast cancer. When to begin using it is a decision that should be based on medical diagnosis specific to a patient’s needs and risk.

Some, like Roe, fear that any change in recommendations on when to begin using mammography will cause health insurance companies to stop covering screening for women younger than 50 or older than 74. He said Thursday that there is no existing age cutoff by Medicare and no plan to do so.
And it’s important to note that the recommendation to increase the age for regular mammograms is for women who do not have a history of breast cancer or other risk factors. Women with risk factors are still encouraged to begin regular mammograms or have MRI screenings in their 40s.

Too often women don’t know what the risk factors are for breast cancer and they don’t confer with their doctor about their needs.
Instead of supposing, ask a medical expert about the screening schedule that is right for your needs. Every woman should make scheduled visits to a gynecologist; put this topic on the list of things to discuss at your next visit.