Breast cancer study challenged
Local survivor, YVMC experts support annual screenings for women
December 6, 2009
■ Learn about the Yampa Valley Breast Cancer Awareness Project and Bust of Steamboat events on the Web at http://thebustofs…
■ Learn about Yampa Valley Medical Center at http://www.yvmc.org
Steamboat Springs — Local doctors, including breast cancer survivor Dr. Rosanne Iversen and cancer experts at Yampa Valley Medical Center, voiced strong opposition last week to a recent study recommending that women ages 50 to 74 have breast cancer screenings every two years.
The recommendations were issued by the U.S. Preventive Services Task Force and published in the Nov. 17 issue of Annals of Internal Medicine. They drew strong nationwide reaction because they contradicted earlier, widely accepted guidelines by organizations including the American Cancer Society, which recommends that women receive annual breast cancer screenings beginning at age 40 and continuing as long as a woman is in good health.
"I think that's what's confusing the public," said Jan Fritz, director of cancer services at YVMC. "It's kind of … who do you believe?"
For Fritz, Iversen, YVMC radiologist Dr. J.D. Gilliland and oncologist Dr. Allen Cohn, of YVMC and Rocky Mountain Cancer Centers, the answer is clear. All four expressed caution and disagreement, or cited outright flaws, with the Task Force study.
None said they would change their recommendations or practices as a result of it.
"I haven't heard much enthusiasm for endorsing these," Cohn said about the recommendations. "It seems to me that there are some faults with the study."
Iversen said neither the American Cancer Society nor the American College of Obstetricians and Gynecologists has changed its guidelines for breast cancer screening. She hasn't, either.
"My own opinion is that women should get routine screening starting at age 40," she said, adding that patients have been asking her lately about the Task Force study.
"I have not changed my recommendations," Iversen said.
She and YVMC spokeswoman Christine McKelvie expressed concern that the Task Force study could affect guidelines for coverage of breast cancer screenings by Medicaid and Medicare.
According to Medscape Medical News, which is affiliated with the WebMD Web site, the Task Force research included "a decision analysis using population modeling techniques to determine anticipated health costs and outcome benefits of screening every year versus two years."
Gilliland said that method does not reflect individual attention to each patient. YVMC's mammography department conducts an average of 2,300 mammograms — and diagnoses about 25 cases of breast cancer — a year.
"There's a difference between a large mathematical model and the concept of patient care," Gilliland said about the study. "It has the appearance of a process leading to a predetermined end point."
Gilliland questioned the data and process used in the Task Force study, which he said was not properly peer-reviewed before the recommendations were issued and should have received a broader range of input.
The Task Force is supported by the federal Agency for Healthcare Research and Quality but makes its recommendations independent of the U.S. government. The Task Force study also recommended against teaching self breast exams, saying self-exams are not linked to a decrease in breast cancer mortality rates.
Iversen found a lump in her breast in January 2007, and a subsequent mammogram led to a diagnosis of cancer. She was 44.
"If I didn't do mammograms or self-breast exams, mine wouldn't have been picked up," she said Tuesday, in her family practice office off Anglers Drive. "And maybe I wouldn't be here today."
Task Force Vice Chairwoman Dr. Diana B. Petitti, a professor of biomedical informatics at Arizona State University in Phoenix, spoke to Medscape Medical News last month. She flatly denied the Task Force recommendations were motivated by cost-cutting goals — "cost was not a word that was uttered," she told Medscape — and said potential harms of screenings included false-positive results and additional tests.
"This recommendation is not a recommendation against ever screening women age 40 to 49; it is a recommendation against routine screening of women starting at this age," Petitti told Medscape.
Gilliland said he disagreed with the model the Task Force used, in part, to reach that conclusion. Gilliland cited Task Force numbers stating that it takes 1,900 mammograms to save one life in the 40 to 50 age group, as opposed to 1,300 mammograms to save one life in the 50 to 60 age group.
"They're basically saying in the 40 to 50 (age group), it doesn't save enough," Gilliland said.
Iversen took a more personal view of the Task Force recommendations.
"I guess the U.S. Task Force is saying my life is not worth that much money," she said.
Iversen and the cancer experts at YVMC emphasized that above all, it's crucial for women to be aware of their health and to speak with their caregivers.
"Mammography is not perfect," Iversen said. "I think women need to be aware of their breasts, and aware of when there is changes with their breasts."
Cohn echoed that point.
"A breast self-exam every month costs absolutely zero," he said.
Julie Isaacs, mammography manager at YVMC, said the hospital opened its new mammography facilities to patients in October. The upgrades include a digital mammography machine and new changing rooms for patients.
Gilliland said the idea was to create the most calming atmosphere possible for patients and streamline the treatment process.
Fritz implied that the attention paid to the Task Force recommendations shows the heightened awareness many women have toward personal health issues and an active mindset toward care.
"Women are going to do what they want to do," said Fritz, a founding organizer of the Bust of Steamboat events held by the Yampa Valley Breast Cancer Awareness Project. "I think women pay attention a little more than men."
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