Thursday, October 22, 2015

New Breast Exam Guidelines Cause Controversy.

The American Cancer Society is feeling the heat after coming out with new guidelines regarding mammograms and breast exams by doctors. It was formerly recommended that women of average risk of breast cancer start annual mammograms at the age of 40. Yesterday's guidelines upped the age when annual mammograms of average risk women to 45 and added that women above the age of 55 years old be screened every two years instead of annually as previously directed. The guidelines also recommended doctors no longer perform breast exams with the somewhat. The American Cancer Society (ACS) sites the large number of false positive as a deciding factor in their new guidelines. Younger women have breast that are more dense than older women making it harder for a radiologist reading the exam to say whether a mass appears to be suspicious or not. Most err on the side of caution (for the patient and fears of being sued for malpractice) and describe the lesion  as " of uncertain etiology" and recommend biopsy. Many then will then be scheduled for surgery to remove the mass which many times comes out to be benign. Much anguish and medical dollars are spent on these procedures each year. The rational for women over 55 years old to be examined every 2 years is that the cancer is so slow in progressing that she would probably die of old age before the cancer would do her in.
Many groups including Breast.com and not surprisingly The American Collage of Radiology and Society of Breast Imagery have been very vocal in their opposition to the new guidelines (not surprisingly I say of the two medical society's mentioned as it would cut down on the amount of studies and thus the amount of reimbursements).
The part that I find most interesting is that the ACS cannot forbid a women, say of 41 who seeks a mammogram. They can only recommend against it as unnecessary. The problem is that most insurances will compensate for procedures that fall within certain guidelines so most likely a woman of 41 who seeks a mammogram at that age may have to pay it out of pocket to the certain delight of many insurers. Many woman may forego the mammogram due to the costs involved.
This will probably not be the last we hear of this, as breast cancer is a leading cause of death for women   in the United States with a great emotional charge for those who have experienced it, and in many cases  those they left behind
BTW: Studies have shown that mammograms do not influence cancer rates

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