A flurry of media requests yesterday as a result of the new guidelines around screening mammograms released Monday by the U.S. Preventive Services Task Force. There were quite a few articles in today’s papers around this issue. Basically, the U.S. task force is recommending women receive mammograms every two years after age 50. This news comes out after at least a decade of the American Cancer Society (and I believe most breast cancer organizations in the US) recommending annual screenings beginning at 40. The government panel concluded the harms of early screening, including false positives and unneeded biopsies, outweighed the benefits. Instead, it recommended women under 50 consult with their doctors if they think they need a mammogram. This has been a controversial announcement in the United States. However, the changes that the U.S. task force is recommending are actually in keeping with what have been established guidelines in most of Canada. In Canada, most provinces start routine screening at age 50.
When we were first starting Rethink Breast Cancer in 2001, I found it very confusing that the screening age in the U.S. was 40 while in Canada it was 50. My emotional reaction at the time was that screening in Canada should be keeping up with the U.S. and that Rethink, an organization geared towards a young audience, should absolutely recommend screening at age 40 too. My own mom’s breast cancer was first detected by mammogram at age 48. After more research and dialogue with screening experts in Canada, we learned that traditional mammogram wasn’t very effective for young women because young women tend to have denser breast tissue than women over 50. At the moment, Rethink Breast Cancer’s guidelines recommend regular screening starting at age 50 but we encourage women in their 40s to talk to their doctors about their individual risk to determine whether they should start with a baseline mammogram and regular screening at an earlier age.
Right now, a politician in Ontario is trying to pass a Private Members Bill that would allow women age 40 and over access to the provincial screening program without a doctor’s referral. Again, my emotional instinct is always that this sounds like a good idea—if it saves even a few lives, that’s huge. I also happen to be without a GP at the moment and I’m sure many women out there are in the same situation. We also know there are GPs out there that are telling young women who have come to them with a breast problem that they are too young for breast cancer and that they should just keep an eye on things. A lot of the young breast cancer patients we meet took a long time to be diagnosed for this reason. Very scary. (Rethink is launching a new campaign in the new year to remind GPs that young women get breast cancer too.) But, while my heart wants to push for easier access to mammograms, I also remind myself that screening is complicated, especially in young women with dense breasts. An experienced, healthcare professional can help to determine a young woman’s individual screening needs as a mammogram may not actually be enough. Patients who have dense breasts are often recommended by radiologists to have additional imaging with either ultrasound or MRI. It is a case by case discussion depending on individual patient risk, age, degree of density, previous imaging etc. and it is hard to include all these factors in a guideline. Part of our work is to help empower young women to know how to talk to their GPs. If they want a referral to a breast specialist, they can get one. It’s the breast expert that will be able to determine next steps.
In any case, the media coverage around screening mammography will certainly get all breast cancer organizations, including Rethink Breast Cancer, revisiting their guidelines. It’s so important we check in on these issues and our guidelines on a regular basis. So much is changing in the cancer world. Rethink Breast Cancer continues to push for creative thinking around all issues relating to young women and breast cancer. It’s clear to me that we need a cost effect screening technique that works well on the dense breast tissue of younger women!
What do you think about this issue? Are you confused? Feeling OK that the U.S. screening advice is now in line with Canada? I’d love to hear from you.
When we were first starting Rethink Breast Cancer in 2001, I found it very confusing that the screening age in the U.S. was 40 while in Canada it was 50. My emotional reaction at the time was that screening in Canada should be keeping up with the U.S. and that Rethink, an organization geared towards a young audience, should absolutely recommend screening at age 40 too. My own mom’s breast cancer was first detected by mammogram at age 48. After more research and dialogue with screening experts in Canada, we learned that traditional mammogram wasn’t very effective for young women because young women tend to have denser breast tissue than women over 50. At the moment, Rethink Breast Cancer’s guidelines recommend regular screening starting at age 50 but we encourage women in their 40s to talk to their doctors about their individual risk to determine whether they should start with a baseline mammogram and regular screening at an earlier age.
Right now, a politician in Ontario is trying to pass a Private Members Bill that would allow women age 40 and over access to the provincial screening program without a doctor’s referral. Again, my emotional instinct is always that this sounds like a good idea—if it saves even a few lives, that’s huge. I also happen to be without a GP at the moment and I’m sure many women out there are in the same situation. We also know there are GPs out there that are telling young women who have come to them with a breast problem that they are too young for breast cancer and that they should just keep an eye on things. A lot of the young breast cancer patients we meet took a long time to be diagnosed for this reason. Very scary. (Rethink is launching a new campaign in the new year to remind GPs that young women get breast cancer too.) But, while my heart wants to push for easier access to mammograms, I also remind myself that screening is complicated, especially in young women with dense breasts. An experienced, healthcare professional can help to determine a young woman’s individual screening needs as a mammogram may not actually be enough. Patients who have dense breasts are often recommended by radiologists to have additional imaging with either ultrasound or MRI. It is a case by case discussion depending on individual patient risk, age, degree of density, previous imaging etc. and it is hard to include all these factors in a guideline. Part of our work is to help empower young women to know how to talk to their GPs. If they want a referral to a breast specialist, they can get one. It’s the breast expert that will be able to determine next steps.
In any case, the media coverage around screening mammography will certainly get all breast cancer organizations, including Rethink Breast Cancer, revisiting their guidelines. It’s so important we check in on these issues and our guidelines on a regular basis. So much is changing in the cancer world. Rethink Breast Cancer continues to push for creative thinking around all issues relating to young women and breast cancer. It’s clear to me that we need a cost effect screening technique that works well on the dense breast tissue of younger women!
What do you think about this issue? Are you confused? Feeling OK that the U.S. screening advice is now in line with Canada? I’d love to hear from you.
Best,
MJ
MJ DeCoteau, Executive Director of Rethink Breast Cancer
Tidak ada komentar:
Posting Komentar