Sticking To Their Guns: Doctors And Breast Screening

A lot of women are concerned about the implications of the new guidelines that have most women begin breast screening at 50 rather than at 40. But maybe they shouldn't be too concerned. Most doctors interviewed about the new guidelines said they weren't going to implement the changes. Director of the fellowship program for gynecological oncology at Massachusetts General Hospital Dr. Annekathryn Goodman said, “It’s kind of hard to suggest that we should stop examining our patients and screening them. I would be cautious about changing a practice that seems to work.”

Over Treatment

A federal advisory panel issued the new recommendations in early November of 2009. The recommendations, which overturn previous guidelines that had been given wide promotion, are meant to cut back on over-treatment. The panel felt that so few women were found to benefit from screening in their 40's that it was better to delay testing and prevent the anxiety that comes with tests and treatment that so often turns out to be unnecessary. Testing women in their 40's saves one life for every 1,904 women screened during their fourth decade.

While some doctors said they well-understood the panel's analysis of the risks versus the benefits of early testing, they knew their patients would not find it easy to come to terms with the change. Dr. Carolyn Runowicz, the director of the University of Connecticut's Neag Comprehensive Cancer Center said, “My patients tell me they can live with a little anxiety and distress but they can’t live with a little cancer.”

Good Odds?

Dr. Jacques Moritz, the director of gynecology at Manhattan's Roosevelt Hospital concurs. There is a concept here that one cancer death in approximately 2,000 women may not be bad odds, but most women would find it very difficult to end up being that one woman who could have been saved but for the new guidelines. “No doubt about it, I’m going to say, ‘Well, you really don’t need it,’ and they’re going to say: ‘You don’t understand. I’m getting the mammogram. I’m not going to take the chance to be the one person that has it,’ ” says Moritz.

Giving the devil its due, most doctors said they'd be glad to tell younger, lower-risk women they don't need mammograms. At the same time, they wouldn't hesitate to tell those patients that both the American Cancer Society and the American College of Obstetricians and Gynecologists (ACOG) were sticking to the former guidelines.