Women everywhere are finding themselves confused this week by the American Cancer Society’s new breast-cancer-screening guidelines: No more routine mammograms before the age of 45 for women with an average risk of breast cancer. No more breast exams, which essentially means that if you feel a suspicious lump in the shower or I feel one on the examination table, you and I should ignore it.
Let me see if I can help you cut through the confusion. The reality is simple: This decision is bad politics, not good medicine.
A main goal under Obamacare is to try to save money by creating a one-size-fits-all health-care solution. This is not my goal, or the goal of other compassionate physicians who are practicing medicine as an art. A protuberance on a breast exam has led me to diagnose several cases of invasive breast cancer over the course of my career. I, along with many other primary- care doctors and gynecologists, encourage patients to examine their breasts regularly. A woman knows the contours of her own breasts better than anyone and can quickly become alerted to a change. Her doctor can then help decide whether the change is significant.
Mammograms are an important arrow in the doctor’s quiver. Breast-cancer screening has been proven to save lives, but follow-up imaging studies and biopsies and surgeries are expensive. So rather than focus on the real problem, which is that bad doctors overreact to a questionable abnormality on a mammogram or a breast exam and perform a knee-jerk biopsy, the ACS is throwing out the baby with the bathwater.
#share#Why is this happening? Obamacare increased the power of the U.S. Preventive Services Task Force (USPSTF), and, six years ago, this group of so-called prevention experts — concerned that mammograms were leading to too many breast biopsies — outrageously advised that a woman should have no mammograms at all until age 50. The ACS resisted, keeping its guidelines at 40 and above — until now. Many insurance companies follow these recommendations, so it is now disingenuous to tell women over 40 to speak to their doctor and then decide (as the new guidelines suggest), because it is unlikely that most insurance policies will now cover mammograms from 40 to 45.
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Meanwhile, with mammograms as an essential tool in a radiologist’s arsenal, close to 40,000 cases of invasive breast cancer are successfully diagnosed every year in women aged 40 to 50 (according to the ACS’s own statistics). There are close to 4,000 deaths a year from breast cancer in this age group, with thousands more who have been saved by mammograms. In the right hands, a baseline mammogram at 40 gives a smart doctor a roadmap to follow. Mammograms are most effective when you can compare one to another and look for changes. With the latest in digital and 3D imagery, mammograms are more accurate than ever. The ACS relied on outdated data in arbitrarily changing the age to onset screening, much as the USPSTF did. Delaying screening until 45 will lead to fewer unnecessary biopsies, but also to more undiagnosed breast cancer.
#related#Mammograms are over 90 percent effective at diagnosing breast cancer early, before it leaves the breast. Having this knowledge may not always extend life, but it improves quality of life and decreases the need for side-effect-riddled chemotherapy and radiation therapy.
In the future, genetic testing will help us determine who can hold off on having a mammogram until 45 and who can’t, but we aren’t there yet. Overmanaging my screening options as a physician will lead to compromised choices that will compromise health.
As health-care costs continue to spiral upward, our government and our health -insurance companies are desperate to cut costs. But cutting too close to the bone can easily backfire. Diagnosing cancer late leads directly to more expensive treatments. This isn’t good medicine, even if these treatments sometimes manage to keep you alive.
– Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical correspondent.