Those pesky breast cancer screening recommendations

Can I ask who is confused over the 'revised' breast cancer screening guidelines? Or should I just ask who isn't confused? Yes, no, yes, maybe, no one, everyone? How old? Not that young, should be older. Well maybe not. Not for everyone. Wait, oh just test everyone. No only for some people, talk to your doctor. That's a lot of different answers.

And in both my cancers I was clearly not a candidate for hitting the so called criteria for any testing. So I just ignore all the comments about too young or too old. Those really should be less likely or more likely instead of age related if you ask me. But they didn't ask me.

Anyway, so the USPTF (US Preventative Task Force) released a clarification on their breast cancer screenings earlier this week. They also claim they were misunderstood. And they want to clear up confusion. Well maybe the confusion was because what they said back in 2009 concerned everyone.

"The U.S. Preventive Services Task Force (USPSTF) released its final recommendations for breast cancer screening Monday in an attempt to clear up some of the confusion.

The group recommends that women at average risk for breast cancer should have a mammogram every other year beginning at age 50 up to the age of 74. Women in their 40s are advised to make an individual decision in partnership with their doctors, since the likelihood of benefiting from screening is lower for women in that age group.

Though this is an update from the group’s 2009 recommendations, the guidelines remain largely unchanged and a draft was released earlier this year.

The report, published in the Annals of Internal Medicine, also concluded that there’s not enough evidence to determine if newer 3D mammography is a good option for routine screening, or if women with dense breasts need extra testing.

The group’s 2009 report drew controversy for questioning the usefulness of mammograms for women in their 40s. But the task force says their words were widely misunderstood."

Blah, blah, blah. So in their clarification here they state that a mammogram every other year is all that is needed starting at age 50 if you have average risk. Let me ask all my friends in their 40's with breast cancer what they think if they had waited until 50 for a mammogram.

Okay, so medically maybe there is some logic in their plan. Or maybe not. If you look at breast cancer occurrence rates (from Cancer.gov):

Age 30 . . . . . . 0.44 percent (or 1 in 227)
Age 40 . . . . . . 1.47 percent (or 1 in 68)
Age 50 . . . . . . 2.38 percent (or 1 in 42)
Age 60 . . . . . . 3.56 percent (or 1 in 28)
Age 70 . . . . . . 3.82 percent (or 1 in 26)

It sees clear that most breast cancers occur after the age 40. So I don't understand this wait until 50 business at all. Now I am even more confused.

Over- and Under-Diagnosis and Treatment of Breast Cancer

I found this interesting discussion on over and under diagnosis of breast cancer and how to avoid it. Its definitely worth the read.

The big take away I found in the article is that the best way to avoid overdiagnosis is to get screening done at a breast center where the radiologists read mammograms daily. Through their jobs, they see many more breast images than other radiologists who are not as specialized and much more apt to correctly diagnose breast cancer.

Also, better education of patients and oncologists will also help with preventing over-treatment. Often the first reaction at a cancer diagnosis is 'get rid of it now and make sure it doesn't come back!' Fear takes over and the reaction of a patient goes instantly to get rid of it.

But maybe if the patient takes time to educate themselves on treatment possibilities the fear can be controlled. And the doctor is educated enough to provide the support to help the patient make the best choices and not the impulsive choices. Then the chance of over treatment can be reduced.

I think that this issue of over treatment and over diagnosis for many ailments needs more awareness and focus. We need better trained medical personnel who are able to better read screening images and provide better diagnoses. We also need additional training for medical personnel to help patients make better decisions. Finally we need more information available for patients to reduce the fear at diagnosis so they are able to make better decisions.

Over testing vs. patient concerns

A new study in Canada states that early stage breast cancer patients are getting too many pretreatment imaging tests. An average of four after diagnosis. That's a lot.

In my case I had a mammogram that went bad and led to an ultrasound followed by a biopsy and a diagnosis. Then my surgeon sent me for an MRI to confirm there was nothing else. Then two surgeries, chemo, radiation, and hormone treatment. At some point a couple years after radiation,  I had a PET scan to confirm some aches and pains nothing - mostly because I was freaking out. Now I just have mammograms. As well as too many doctors wanting to check for lumps.

I am not sure what other tests I could have or should have had. Or needed. I think I got my share of radiation through all of that. So I am not sure what other screens I really needed.

But let's go back to the freak out I went through and a doctor sent me for what was probably an unneeded PET scan that found nothing. (I  no longer see this doctor, my radiation oncologist, as she used to tell me I shouldn't work because I had cancer and my husband should support me fully and other stupid statements.) This makes me wonder how many other doctors send patients for unneeded scans just because the patient mistakenly believes they have metastases. The doctor does the easy thing and sends them for some test so they do not have to deal with the freak out part.

In my opinion this goes back to the bedside manner stuff that isn't very present in medical school. If a patient is stressed about something, I do not think that sending someone for scans is always the right way to resolve the issue. I think it deserves an in depth conversation that includes the current screening standards, odds of their being an issue, and how to cope with the stress.

I asked my back pain doctor about more scans for my back as it had been five years since my last spine MRI. His response was there is no need for one as nothing indicated anything had changed. I can live with that kind of response. It keep me from being stressed - no indication of any changes. What if that my radiation oncologist had started a conversation with me about reasons the PET scan was not indicated?

In view of increased medical over spending and over treatment concerns, more conversations are warranted instead of more testing.

$1500 for an MRI

This was in the Boston Globe on June 12, 2015.

I had to post it. Too funny.  But not funny 'ha ha'.