Wednesday, November 18, 2009

Dr. Sharon Ward has diagnosed a half-dozen women in the past five years with breast cancer. All but one of them were younger than 50.

That's why Ward, who has a gynecology and obstetrics practice in Key West, is troubled by a government task force's recent recommendation that most healthy women shouldn't begin routine mammograms until age 50.

New breast-screening guidelines were released Monday by the U.S. Preventative Services Task Force, and doctors around the nation and locally are questioning the findings.

The task force recommends against mammograms in women 40 to 49 years old without a history of breast cancer in their family and suggests that women 50 and older should have mammograms every two years instead of annually. The panel also says self breast exams provide little or no benefit.

These new guidelines go against what doctors have been telling women for the past 20 years.

Ward said if her patients had waited until age 50 to have a mammogram, they'd likely all be dead.

Marathon resident Charlotte Quinn is one of those women. She was diagnosed with breast cancer at age 41.

"I am appalled that this information has come out, because if it hadn't been for mammograms starting at age 40 for me, I wouldn't be here today," said Quinn, now 63, who battled the disease again in her early 60s.

Quinn's daughter was screened at age 40 and also was diagnosed with the disease.

"If she hadn't gotten hers when she turned 40, she wouldn't be here today either," Quinn said. "Putting it off until age 50 is a risk I am not willing to take and I wouldn't recommend to anyone."

Ward said she will continue to follow previous guidelines and urge patients to start mammograms at age 40 and continue self breast exams, which is the recommendation of the American College of Obstetricians and Gynecologists.

The organization released its own statement Monday in response to the task force findings, saying it disagrees with the new suggestions and urges its members to continue screenings beginning at age 40 and teaching patients how to check their own breasts at home for irregularities.

Ward and her colleagues believe self breast exams are a critical tool for detecting cancer in its earliest stages.

"If you're not doing breast exams, then you're not going to find something early," she said. "And by the time I see you six months or a year later, it may be too late. Breast cancer these days is very treatable, especially if we catch it early."

Key West resident Leslie Concepcion felt a lump in her breast at age 39, shortly before her first scheduled mammogram. She was diagnosed with cancer and successfully underwent chemotherapy.

"I think it's terrible that this (new guideline) has come out," she said. "I think it lulls a lot of women into having this false sense of security. And the whole thing about breast cancer is early detection. That was key for me."

Because Concepcion caught her cancer early, she responded well to treatment and even went on to give birth to a son, now 6 years old.

"If I had waited to have a mammogram, God only knows what would have happened," she said. "We as women have to know our body. And doing these self-exams are the first step in really knowing and understanding our bodies."

Ward and Dr. Sandy Shultz, a radiologist at Lower Keys Medical Center, said cancers found in women younger than 50 often are more aggressive, which makes their early detection so important.

Shultz said many of the mammogram films he's analyzed of cancer patients in the Keys and as the head of a radiology clinic in Savannah, Ga., involved women under the age of 50.

"It's very common," he said. "The cancer that we see in the younger patients seems to be a much more aggressive cancer. So if you miss it, the chances of survival are diminished."

Shultz, a radiologist of 29 years, said when he was running the clinic in Georgia he fought strongly to get the screening age brought down to 40 because he believed it was so important.

"I'm not changing my opinion on this," he said.

The American Cancer Society's Florida Keys Unit will not change its guidelines to align with the task force's recommendations either, said the chapter's local medical adviser, Dr. Rose Chan, a general surgeon in Key West.

"There is no new evidence that would lead the American Cancer Society to change its guidance to women about mammography screening for breast cancer," she said. "We strongly urge women to continue to follow our guidelines."

Chan said the society has documented a noticeable decline in breast cancer deaths -- 29 percent since 1989 -- which it directly attributes to increased screening.

During the 1980s, about 13 percent of women were getting mammograms, and the size of the tumors detected averaged 3 centimeters, she said. By the late 1990s, 60 percent of women were getting mammograms, and the average tumor size had decreased to 2 centimeters.

Also during the 1990s, the number of breast cancer-related deaths for all women dropped 2 percent each year. For women under 50, the drop was even more significant, at 3 percent a year.

The task force's scientific analysis says that for women age 49 and younger, 1,904 women would have to have a mammogram to save one women's life. By comparison, for women 50 and over, 1,339 women would need to be screened to save one women's life, a difference of 565 women.

Chan said she does not agree with the group's justification that having an additional 600 women tested for the sake of saving one life is not important.

She acknowledged that mammograms have limitations, including false positives that lead women to undergo biopsies -- something the task force deems an unnecessary risk. But Chan said she believes most women would rather undergo a biopsy than risk not catching cancer early enough to be treated.

She also said she's seen plenty of patients who first discovered their breast cancer through self-exams, and feels strongly that women should continue to do them.

"It's not about feeling for a lump; it's about getting used to the way the breast feels," she said. "If it feels different, that is the time to bring it to your doctor's attention."

Both Chan and Ward said they are wary of how health insurance companies will use the task force data.

"One other concern coming out of this, which is important, is the implication that it allows the insurance companies to deny screening," Chan said. "It gives them room to deny people care. That's significant."

Ward agreed.

"I think insurance companies are going to use this as a reason not to cover mammograms in women who are under 50," she said, adding that it was "interesting that the timing occurs with the discussion of socialized medical care."

amswary@keysnews.com