Vickroy: End the debate, start mammograms at 40
BY DONNA VICKROY firstname.lastname@example.org Twitter: @dvickroy September 16, 2013 11:01PM
Palos Community Hospital doctors Erwin Thimm (left), a mammogram radiologist, and Kanesha Bryant, a breast surgeon, remind women that yearly mammograms are needed after age 40. | Donna Vickroy~Sun-Times Media
Updated: October 19, 2013 6:57PM
The American Cancer Society, the American Society of Breast Surgeons, the National Cancer Institute, and doctors Kanesha Bryant and Erwin Thimm, of Palos Community Hospital, would like you to know one thing: Women should have annual mammogram screenings beginning at age 40.
Period. End of discussion. Put it on the board.
“All the research has shown that for women over 40, yearly screenings should be the norm,” said Thimm, a mammogram radiologist at the hospital.
There has been a lot of confusion concerning the age women should start getting screenings and how frequent those tests should be, particularly since the U.S. Preventative Services Task Force threw a wrench in the medical community’s longstanding recommendation in 2009 when it announced that women should wait until 50 to start, and that screenings should occur every two years.
Since then, Thimm said, there has been a notable decrease in the volume of mammograms conducted across the country. The Mayo Clinic estimates the drop to be about 6 percent.
But a study published just last week in the journal Cancer shows a significant difference in the death rate in women younger than 50 who opt not to have regular mammograms. That study, conducted by Harvard Medical School, looked at more than 600 breast cancer deaths between 1990 and 1999, as well as those patients’ mammography records.
The findings show that 71 percent of the deaths were among women who had never had a mammogram or for whom it had been more than two years since their last screening. The study found half the deaths occurred in women younger than 50, while 13 percent were 70 or older. The women who died were a median age of 49 at diagnosis.
“Younger patients tend to have more aggressive tumors,” said Bryant, a breast surgeon.
With earlier detection, she said, there is a decrease in the morbidity rate and an increase in the number of options for treatment.
“We know that less invasive procedures tend to lead to better recovery,” she said.
So why would anyone recommend that women start later or have less frequent screenings?
Thimm said regardless of the USPSTF’s agenda, it must be pointed out that the group’s recommendation is not based on any new medical study or research.
“It is unclear why you tell people to have screenings less often,” he said.
He likened it to the panic over vaccines, which many doctors now cite for the return of whooping cough.
“An idea gets out there and then various groups coalesce around it and before you know it there’s a movement toward the extreme,” he said. That doesn’t mean the movement is good for the public, however, he said.
“Our recommendation is based on medical research,” he said. “We do studies to show an efficacy of the process.”
Thimm said there has been no study to support recommending women wait until 50.
Even the U.S. government supports the medical community’s recommendation, Thimm said. The Affordable Care Act recommends annual screenings, and Medicare will pay for women 40 and over to have the yearly test.
Yet, he said, many women embraced the USPSTF’s change in recommendation because of fear of a false positive or simply because it appeals to their comfort zone.
“Mammography is far from perfect,” Thimm said. “But it has clearly been shown to save lives.”
Bryant said it is difficult for many women to come in for a screening when they are feeling fine — sort of the old “Why go looking for trouble?” mentality.
Thimm said some woman cite the discomfort or inconvenience of the procedure, even though many screening facilities, including Palos’ newly opened Breast Care & Women’s Health Center in Tinley Park, boast a comfortable, private, spa-like setting.
He believes there is another reason at the root of the reticence.
“The only purpose of the screening is to look for cancer,” he said. “In the end, most women who complain about pain or other things associated with the screening are really just scared of the diagnosis.”
Yet, both doctors said, the benefits of early detection far outweigh any of the inconveniences of the screening.
The Breast Care & Women’s Health Center is at 17333 S. LaGrange Road, Tinley Park; (708) 827-2030; bit.ly/mammo2013.