May 27, 2011 / 9:23 PM / 9 years ago

New breast cancer guidelines "unsafe": women

NEW YORK (Reuters Health) - More than eight out of 10 women say new guidelines recommending against routine breast cancer screening of women under 50 are “unsafe,” according to a small survey.

But most of the women also grossly overestimate their risk of developing the disease, researchers from the University of Massachusetts Medical School in Worcester found.

“Indeed, they have been exposed to consistent and high profile media campaigns, endorsed by medicine and a variety of interest groups, that have indoctrinated them into the concepts that mammograms lead to early detection and early detection saves lives,” the researchers write in the American Journal of Obstetrics and Gynecology.

The controversy over screening mammography flared up in late 2009, when a government-funded group of independent experts decided to change its recommendations.

Instead of advising annual mammograms in all women age 40 and above, the U.S. Preventive Services Task Force (USPSTF) said women shouldn’t routinely get screened until they hit 50. And those between 50 and 74 should only have mammograms every two years.

What the group didn’t say, however, is that no women under 50 should be screened. It left that up to the individual woman and her doctor to decide based on her personal risk factors and preferences.

But the USPSTF recommendations flew in the face of many years of aggressive PR campaigns, and met staunch resistance from advocacy groups, news organizations and medical groups alike.

To find out what women themselves think, Dr. Autumn Davidson and her colleagues gave questionnaires to 247 women in their 40s, who came to the hospital for an annual well-woman exam.

More than eight out of 10 of the woman said they wanted yearly mammograms, felt the new USPSTF guidelines were unsafe, and wouldn’t delay screening until they turned 50.

Most of them also had an inflated sense of their breast cancer risk. On average, they put US women’s lifetime risk of developing the disease at 37 percent.

Here’s what scientists agree on: over their lifetime, 12 percent, or one in eight women, will get breast cancer.

According to Dr. Michael LeFevre of the USPSTF, about 30 out of 1,000 40-year-olds will die from the disease in the absence of screening.

If screening is started at 50 and done every two years until the women hit 75, seven of those deaths would be prevented. Starting at age 40 instead would stave off one additional death.

From an individual woman’s point of view, that extra risk reduction is real, but quite small. And it comes with a price tag.

For some women, LeFevre said, mammography is a painful experience, and at least one in two who are screened annually throughout their 40s will trigger a false alarm — that is, the mammogram shows a suspicious mass that turns out not to be dangerous.

In the meantime, the woman has gone through additional testing, which exposes her to more radiation, and sometimes had a painful, invasive and expensive biopsy done.

“Some women respond with increased stress and anxiety and apprehension,” LeFevre told Reuters Health. “The decision should be an individual one.”

A typical breast biopsy procedure, stereotactic core biopsy, costs $2,000 or more. Surgical biopsies involve general anesthesia and higher costs. About four in five women referred for biopsy based on suspicious mammograms turn out to not have cancer.

Yet, according to the new survey, women who’d had false-positive results were less likely to want to delay screening until they turned 50 — perhaps because they get extra worried about breast cancer, suggested LeFevre.

In his view, LeFevre said, advocacy groups have given women an unrealistic perception of how common breast cancer is and to what extent screening is helpful. On the other hand, the groups have undersold the potential harms of screening.

“To encourage women to have mammography there have been some fairly strong public relations campaigns,” he said, “For instance, there has been one in the past saying that if you’re not having annual mammography you need more than your breast examined.”

Elizabeth Thompson, president of Susan G. Komen for the Cure, a large advocacy group based in Dallas, Texas, said her organization worried that USPSTF’s new recommendations would prevent women in their 40s from being reimbursed for screening.

The group, along with many others, recommends that women in their 40s should have a mammogram every year starting at age 40 if they are at average risk.

“Our advice is always to talk with their doctors about their risk,” said Thompson. “Forty percent of the women who are eligible to be screened aren’t being screened.”

She added that the new survey is small, and might not be representative of American women in general.

“I don’t think today that we have fear-mongering when one in three women will be diagnosed with (any form of) cancer in their lifetime and one in two men,” Thompson told Reuters Health.

The survey also showed that women’s opinions are colored by the news they read.

After reading two published newspaper articles about the USPSTF’s new recommendations, women who were given a story that was favorable to the USPSTF were less likely to believe they should get mammograms in their 40s — yet more than 80 percent of them still believed they should.

“As we strive to move toward a more evidence-based system of health care, it would be beneficial for policy makers, health care providers, and media outlets alike to recognize the crucial role the press plays in shaping patients’ opinions, and this should be factored in when considering recommending change,” Davidson and her colleagues write.

SOURCE: American Journal of Obstetrics and Gynecology, online April 15, 2011.

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