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Experts disagree with the new federal guidelines for breast cancer screening

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Stanford experts disagreed with the new federal guidelines on breast cancer screening. The new guidelines were mamogramsreleased by the United States Preventive Services Task Force back in November. The guidelines would delay first mammogram  screening to women by 10 years to start at age of 50. It also reduces future screenings from being annual to be done in longer intervals, and would end screenings for women after the age of 74. The new guidelines will apply only to women at average risk for breast cancer, not those with high-risk for it.

On the other hand, “Controversies in Screening for Women’s Cancer” program presenters said they’ll continue to support older breast cancer screening guidelines, recommended by the American Cancer Society back in 2003, which called for annual mammogram screenings starting at age of 40.

Debra Ikeda, MD, director of Stanford University Breast Imaging, said she disagreed with the Task Force’s guidelines that mentioned that the number of women saved by annual mammography screening at their 40s can be neglected in comparison with the risks of screening for women of that age. Ikeda said “Women need to know that [by performing routine mammograms] there may be false positives and a need for biopsies,” she added “But women should make that choice for themselves, with a doctor’s help. Debra Ikeda, a professor of diagnostic radiology, expressed concerns that the new guidelines will lead some women to miss early cancer detection, when it can be treated easier. Ikeda said “With that longer interval between mammograms, we’ll start seeing more higher-stage cancers.”

Still, the possibility of false diagnosis and determination of the severity of breast cancer is a risk appearing during routine mammograms. Ikeda said “the problem I have is, how do I know which cancer is going to kill a woman and which one won’t? I don’t want to take that chance.”Ikeda said that there is no dependable test to differentiate between deadly breast cancers and cancers that are less harmful. She mentioned that the benefits of annual mammograms for women in their 40s are more than the U.S. Preventive Services Task Force has stated. Ikeda said that Service Task Force data did not reflect recent advances in breast imaging technology.

The American Cancer Society and the American College of Obstetricians and Gynecologists were among organizations disagreeing with the new breast cancer screening guidelines and these organizations preferred the previous guidelines.Robert W. Carlson, Professor of oncology, MD, and a presenter at the “Controversies in Screening for Women’s Cancer,” program, said he backs up the previous guidelines. He expressed concerns that the new guidelines could lead insurers to limit coverage of breast cancer screening.Yet, Carlson said that the Task Force’s new guidelines resemble different opinion from a political point of view. He added that performing screenings every two years for women at age of 50 would be reasonable putting in mind the need to use limited resources for greatest outcomes.  He added that annual screenings at the age of 40 would include about 50,000 women to be screened, and the cost would be millions of dollars.

Another issue recommended by the new guidelines was not to teach women to carry out with self-exams for breast cancer. The guidelines also questioned clinical breast exams importance.A study was carried out on 250,000 women in Shanghai showed that self-exams did not improve cancer detection rates or mortality rates. Furthermore, the study mentioned that the women in the breast self-exam group had more biopsies than the control group, but the number of cancers found and the number of cancer deaths was similar in both groups. According to that study, Prof. Carlson said he does not recommend women to do breast exams by themselves.

Finally, “Controversies in Screening for Women’s Cancer” program presenters expected the guidelines will undergo further revision. “It’s critical that we study this more and we study it carefully,” said Jonathan Berek, MD, director of the Women’s Cancer Program at Stanford, professor and chair of obstetrics and gynecology and a presenter at the program. “It’s critical that we don’t have limits on our resources while this gets sorted out.” he added.


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