Sunday, November 22, 2009

Mammograms and Self Breast Exams

The new United States Prevention Services Task Force guidelines came out this week saying we should no longer ROUTINELY order annual mammograms on 40-49 year old women. What?? I am a 40-something year old female with no family history of breast cancer, so this impacts me not only as a provider, but as a patient. Do I want an annual screening mammogram? Well, yes, I do.
I have had too many patients and friends my age and younger get breast cancer, and have already lost one amazing friend to this disease. AND I have had 3 patients find their own breast cancers through self-breast exams, so I also will continue to instruct my patients on this technique, despite the recommendations to discontinue this process. All three of these women detected cancers early enough to have complete cures with minimal surgery/chemo.
Know that there are completely conflicting opinions on this subject (like most every topic in medicine!) We obviously view this recommendation through our very select vision of our patient populations and our specialties. The ACOG (American College of Obstetrics and Gynecology) and the American Cancer Society are dead set against changing our current practice- but remember, they (and I) are coming from seeing real women in their 40s fight breast cancer- and some do not win. When you are sitting around reviewing outcome studies and looking at statistics, it is far easier to be objective, because you are not thinking of "Shannon" but simply looking at numbers.
Are some women being "harmed" by false positive mammograms, resulting in extra cost, mental anguish and unnecessary procedures (biopsies, further imaging)? Certainly. This is what the task force is trying to reduce, and it is an important point to consider as we decide how to best spend our health care dollars. However, on an individual basis, I'd rather do superficial "harm" by false positives than miss the early cancers we might detect and CURE.
Remember, though, that these are GUIDELINES, not edicts, and physicians are encouraged to make individual decisions based on their full knowledge of the patient and her extended history.
The art of medicine is exactly that- not black and white treatments and diagnoses, but many shades of grey. I choose to continue to teach self-breast exams and encourage annual mammograms starting at age 40, and hope our research continues to yield better options for early detection and treatment.