Many Doctors to Stay Course on Breast Exams for Now

Many Doctors to Stay Course on Breast Exams for Now

By PAM BELLUCK
Published: November 17, 2009


Despite new recommendations that most women start breast screening at 50 rather than 40, many doctors said Tuesday that they were simply not ready to make such a drastic change.

“It’s kind of hard to suggest that we should stop examining our patients and screening them,” said Dr. Annekathryn Goodman, director of the fellowship program in gynecological oncology at Massachusetts General Hospital. “I would be cautious about changing a practice that seems to work.”

The recommendations, issued Monday by a federal advisory panel, reversed widely promoted guidelines and were intended to reduce overtreatment. The panel said the benefits of screening women in their 40s — saving one life for every 1,904 women screened for 10 years — were outweighed by the potential for unnecessary tests and treatment, and the accompanying anxiety. Women considered at high risk should continue to have early screening, the panel said.

Several doctors said that while they understood the panel’s risk-benefit analysis, their patients would not see it that way. “My patients tell me they can live with a little anxiety and distress but they can’t live with a little cancer,” said Dr. Carolyn Runowicz, director of the Neag Comprehensive Cancer Center at the University of Connecticut.

The idea that one cancer death is prevented for roughly 2,000 women screened “doesn’t mean anything until you’re the one,” said Dr. Jacques Moritz, director of gynecology at Roosevelt Hospital in Manhattan. “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.’ ”

more...

http://www.nytimes.com/2009/11/18/health/18doctors.html?_r=1&hp

I am glad doctors are battling this. Sadly, for some lawmakers, it takes it happening to men before they "get it."

who get b.c. before the magical age of 50 aren't worthy of living? And if it takes men to alter the current recommendation, that would disgust me though I know men's wellness is of primary importance. :eyes:

to attack. Get over yourself.

Breast cancer DOES happen to some men. That's why it's important for men to know they are not immune to it.

Breast cancer also happens to some young women. When it does, it tends to be more aggressive. That's why it's important for them to know they are not immune to it.

However...it would be both a waste of resources, and WRONG, to flood the media with messages that breast cancer is a serious danger for a statistical majority of men and young women, and to advocate that, because of this, they get annual mammograms to look for it.

The fact of the matter is that very few of them would be better off for such screening, and many of them might be subjected to doses of radiation that would INCREASE their chances of getting breast cancer.

So what makes sense for these groups is awareness that it can happen, and for them not to discount (or allow anyone to discount) it if they feel a lump or feel something is wrong, or if something is found during a clinical exam. Young women who have a higher risk because of their family history would also want to take special care.

But it would just be plain wrong to pound the message of awareness into these groups' brains to the point where they demanded overscreening and overtreatment for something they are less likely to have a problem with than older women.

Breast cancer is still primarily a disease of older women, not younger ones and not men. That doesn't mean the young women and the men who get it don't count, or shouldn't know they are not immune to it. By all means, no! But what it does mean is that it would be a mistake to overfrighten them about their risk and overscreen them using the most widespread tool available to us today, mammography.

And I say that not as a medical expert, I admit, but as a person who's read up and learned a lot on this topic, and listened to people who ARE doctors.

and a physician representing the ACS -he was refuting her study and advising women to get yearly screening after 40.

The author, dr. diana petitti, was also the co-author involved in the study that said teaching self breast exam did not result in lower mortality levels for breast cancer. So she has two controversial studies for this group under her belt.

I think her methods or how she's interpreting data or organizing her data are going to be questioned.

When she was questioned on PBS about the breast-exam study of a few years ago, her study qualified discovering a mass in one's breast in the shower (which her study said was how most malignant breast lumps were found -as opposed to routine breast self-exam) as not being a routine breast exam...(!!).

So when is feeling one's breasts for lumps not feeling ones breasts for lumps? How do you account for the thought processes involved in self-exam or "accidental" self-exam..exam?? Is separating these ways of finding breast lumps an actual mathematical methodology?

Did the co-author analyze to what extent women (or men) who found lumps in the shower had already been shown how to examine one's breasts, or if they'd heard about it through the media? On what imaginary scale can you analyze to what degree people who've had breast cancer and found it in the shower were influenced by public knowledge of breast self exam??

To me how she's defining her numbers, or her or the study's premise, seems to be based on something that is not within the realm of being mathematically measurable.