Mammogram recommendations: What's next?

Some intense reaction to the new advice on mammograms. A government task force, the  U.S. Preventive Services Task Force, recommends women wait to get mammograms until they are 50, which goes directly against what women have been told for decades, which is to get them in their 40's.

Some say it's a dangerous way to save on health care costs.

Others contend those early mammograms just aren't needed.

But regardless, the debate leaves the patient in the middle, wondering what to do, especially if insurance may not pay for that yearly mammogram anymore.

At Fairview Southdale Hospital in Edina, the new recommendations won't change the way oncologist Dr. Barbara Bowers treats her patients. 

She says, "Almost every patient is outraged by this.  They're so upset."

The task force recommends no routine mammograms for women ages 40-49.  Instead, it says they should start getting one at age 50 and every two years after that.  The exception is those at high risk.

But Bowers says, "Only one in ten of our breast cancer patients have a family history."

The American Cancer Society disagrees with the task force's advice on mammograms and will continue to recommend annual mammograms for women age 40 and older.

Meantime, the task force says for women ages 40 to 49, one death is prevented for every 1904 routinely screened. For women ages 60 to 69, it's one in 377.  It says younger women's denser breasts lead to more false-positives, unnecessary tests and biopsies... essentially more harm than good.

But Bowers believes there are statistics to support her argument too. 

She says breast cancer patients younger than 50, "already account for 40% of the breast cancer deaths and the only chance that we have to decrease the number of those patients who die from the disease is to find it early."

When not caught early, she believes the costs are higher.  She says, "The cancer will be more obvious, it will be larger.  It will cost society more to treat that cancer."

An insurance industry group, America's Health Insurance Plans, has said the recommendations won't likely affect insurance coverage of mammograms. But Bowers fears they could.

The average cost of mammograms in 2005 was $125.  But it can range from $50 to hundreds of dollars.  However, there are some programs, like the Sage Program with the Minnesota Department of Health that provides mammograms to the uninsured and underinsured for a lower cost or free.

The recommendations also say breast self-exams don't prevent deaths and therefore doctors should not teach their patients how to do them.  The American Cancer Society agrees on this point.  It no longer recommends breast self-exams. 

But Bowers believes self-exams are important for women.  She says women, especially young women, need to be in tune with their bodies.  She says, "Those are the people that have the more aggressive breast cancers and should be more aggressive in their breast exams."

Instead of recommending routine screenings for fewer people, Dr. Bowers believes we should find better and cheaper ways to screen. 

She says digital mammography is far better than film mammography at finding cancer in denser breasts.

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