Physicians cautious on mammogram changes

Photo by Gretel Daugherty—In a darkened room in Community Hospital’s radiology department, Don Nicolay, M.D., examines digital mammograms on several computer screens. Nicolay is the chief medical officer of the hospital.

For as long as most women can remember, turning 40 means getting a mammogram that year and every year after.

That thinking shouldn’t be absolute, according to recommendations released recently from a U.S. Department of Health panel.

The commissioned report from the U.S. Preventive Services Task Force recommends women instead receive biennial screenings after age 50 and recommends against physicians teaching women about how to perform self examinations.

The new guidelines aren’t intended to include women with a family history of breast cancer and other factors that may make them at high risk to develop the cancer.

Dr. Don Nicolay, chief medical officer at Community Hospital, said the new recommendations mainly have caused confusion and questions.

However, the recommendations won’t result in any blanket changes over how and when mammograms are performed at the hospital. Those decisions will be made by the female patient after consulting with her primary care physician.

“That’s why I always say the doctor-patient relationship is important,” Nicolay said.

According to the study, the recommendations shouldn’t change whether health insurance kicks in for the procedures for low-risk women between 40 and 49 years old.

Digital imaging mammograms, which are used by Community Hospital, are much more accurate in revealing early diagnosis and use less radiation than mammograms of the past, Nicolay said.

With regard to the recommendation that physicians not teach self-breast exams, “I would take issue with that,” Nicolay said.

A number of women over the course of his career who suspected lumps to be cancerous were ultimately diagnosed with breast cancer, he said.

Radiation from mammograms, the study says, may increase the risk for breast cancer, but it’s not likely.

“... Although regular mammography could contribute to cumulative radiation doses from additional imaging for other reasons,” the study said.

The study claims the potential harm in mammograms include false-positives, which can lead women to endure unneeded anxiety and invasive procedures.

It also cites over-diagnosis as an issue if women are having unnecessary biopsies for slow-growing cancers that would never cause death.

Nicolay said the science behind the study is sound, that women in high-risk categories who develop aggressive breast cancer will develop it in their 20s, 30s and 40s, but the risk doesn’t generally increase for low-risk women until their 50s and 60s.

“You should still get checked out if you have high-risk factors,” he said.

Breast cancer is the second leading cause of death of women in the United States, according to the National Breast Cancer Foundation.

The incidence of breast cancer in women has increased from one in 20 in 1960 to one in eight today.

However, early detection can greatly increase survival rates to more than 95 percent, the foundation reports.


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