New York Times "Addicted to Mammograms"

swimangel72 · November 2009

This op-ed piece was written by an internist and a professor of the history and sociology of science - and no doubt by someone who NEVER experienced the horror of breast cancer in his family!

http://www.nytimes.com/2009/11/20/opinion/20aronowitz.html

Edited to remove my misquote: - the author did NOT suggest that treatments "create a culture of fear" - rather that an early anti-cancer campaign created a "culture of fear". I believe that statement is speculative on the author's part.........I'd like to see his bibliographic references...........in my mind, the "fear" has always been there, since humans first walked upon the earth - it's the fear of disease and death. Frown

iodine · November 2009

Oh, I just love when ivory tower MD's offer opinions about something that MD's who actually practice medicine know way more about.

even more important than having a family member with bc, I would like to know if he's ever had to go knee to knee and eye to eye with Any patient and tell them they have cancer---of any form.

I doubt you will find any doc who has had to say these words tell you it was not one of the hardest things they have ever had to say. at least when the doc tells you someone has died, they can usually say, we did all we could----not with a cancer diagnosis.

Colette37 · November 2009

OMG! What a pathetic individual to say the least! Have you seen the senate bill where it talks about the USPSTF..the "Task Force"...being the panel that "Recommends" the standard of care? It starts on page 17 of the 2,000+ page bill.

http://www.scribd.com/doc/22734971/Senate-Democrats-Health-Care-Reform-Bill

Isn't it disgusting what they are doing?

Colette37 · November 2009

Here is about the "Panels" own website. The U.S. Preventive Services Task Force actually call it a "Panel"

http://www.ahrq.gov/Clinic/uspstfix.htm

Who was the person who coined the term "death panels?" The people on this panel should be ashamed of themselves...I guess it is all necessary so they can create the north American Union.

AnnNYC · November 2009

Swimangel, I found that article SO offensive and condescending.

And Iodine, I think what you're saying about ivory tower MDs who don't deal with patients describes the whole Task Force panel who came up with the guidelines -- although many of them were never MDs, but are ivory tower PhDs...

A front-page news story in today's Times seems to confirm what I suspected about the Task Force -- they're complete clueless, politically and socially and emotionally, not to mention inexperienced with breast cancer...

The headline kinda says it all:

Mammogram Debate Took Group by Surprise

Dr. Diana Petitti, the vice chairwoman of the task force, said Thursday that she had been taken aback by the reaction. She did not realize, she said, the extent of the context. There has been an intense controversy over the screening of younger women, dating back more than a decade and involving Congressional hearings.

"I was relatively unaware of it," she said. "I have been made aware of it now."

Dr. Michael LeFevre, another task force member, said he, too, had been caught off guard by the way the guidelines were received. The task force's message was distorted, he said, into a purely negative one, when the group meant to encourage women to make their own decisions.

"It's partly our fault," Dr. LeFevre said, adding that the group would now be trying to figure out how they could have gotten their point across without stirring such a controversy.

2GIRLSII · November 2009

Ann, thanks for posting the quotes from the article. Wow, where did they get these people. They tell women NOT to do self breast exams and are taken aback that this created a controversy. Honestly, I think some of these folks in Washington think that most Americans are just plain dumb and easily manipulated. I also think there are some out there that will defend ANYTHING that falls on their side of a political line. They don't care what the truth is or who it hurts, they care only about promoting a political agenda and it is totally sickening.

Colette37 · November 2009

This has nothing to do with their being surprised. They have full intentions of keeping these guidelines...they were just hoping that the health care bill would have already been passed before they changed the age like they did with the mammograms.

Yes, there has been a debate, but no one in the medical community never stated to start at 50...and certainly never said anything about women NOT doing SBE like their "Panel" states!

TenderIsOurMight · November 2009

To ROBERT ARONOWITZ, NYT: "Addicted to Mammograms"

"Maybe we're angsting over a technique whose time might, could and should soon pass?"

For a breast screening tool to be "efficient" in early disease pickup of breast cancer it must:

a. Be sensitive and specific (pick up breast cancer, and turns out to indeed be breast cancer).

b. Be widely available and utilized

c. Be safe

d. Be low cost

The death rate from breast cancer in the US (sorry, understand our situation best so using it as an example) has indeed dropped slightly over the last two decades but not enough or a lot.

To drop the death rate from breast cancer, it seems to all you have to pick up those "aggressive" breast cancers very early in addition to slow growing breast cancer. These high grade, high Ki67, proliferative cancers sometimes are described as "coming up over night" or "grew from a pea to a walnut over several weeks".

Sticking strictly to the "screening for bc" issue, it's these aggressive bc in addition to the slow growers any screening technique wants to visualize. Sometimes the aggressive cancers "pop up" between the time of the past mammogram and the new diagnostic mammogram and ultrasound done for the lump which confirms the bc. Most studies show that aggressive breast cancers are often found in younger patients (which we here confirm).

Mammograms done in the young patient are hampered often by the natural breast's density. This causes a white out effect on the mammogram and may mask early lesions. It's precisely these small aggressive lesions in women which must be found on a screening tool to maximize lower stage. Interval lesions (lesions arising between last mammogram and now) had to start somewhere, be some size (e.g.,3 mm or such), possibly show some background reaction on a test (altered architecture, complex cyst part solid, microcalcifications) which better screening tools may detect.

The mammogram remains the gold standard for screening for breast cancer- for now. Quickly on it's heels though is the breast MRI. We all know about it's false positives and the cry for unneeded biopsy. We're declined MRI because of cost, and lack of studies on early disease at this point.

Breast MRI's take breast imaging to a new level. To me, it makes the mammogram look like an archeic outdated tool. When and if our medical researchers and physicians and most importantly our biomedical engineers can further refine breast MRI's technically, to see microcalcifications, to further clarify the activity of a breast lesion (who knows, maybe with a contrast specific for ER/PR as well as a antibody known to be present in the majority of triple negative bc's or an antibody contrast to protein Ki67 if this might be developable), a new era in breast screening impacting early detection in the masses and resulting in a decline in the death rate from breast cancer may occur.

This doesn't have to be wishful thinking in America or elsewhere. If it is decided to a) better engineer breast MRI's b) train technicians on their accurate performance c) limit inter and intra-variability on reading by trained radiologists and give them malpractice relief and d) mandate lower cost of the MRI, well then our joint goal of reduction in breast cancer mortality might be reached.

We don't hear much discussion even in this stirred debate about alternatives to mammograms because it's so cheap and widely available. Perhaps it's time to at least bring forth debate and consideration of a comprehensive screening technique aside from mammography. What we save in chagrin as we see our loved ones suffer with late state disease, as well as the legitimate costs of helping them, might push/incite well done investigation on a mass scale of mammogram alternatives. To date, imho, the breast MRI at least puts us in the right ball park for consideration.

My best to everyone this morning,

Tender

Bren-2007 · November 2009

These are the last two paragraphs in the article Dr. Aronowitz wrote:

"Critics of this week's recommendations have poked holes in the Preventive Services Task Force's data analysis, have warned against basing present practice guidelines on the older imaging technology used in the studies, and have called for still more studies to be done. They generally sidestep the question of whether the very small numbers of lives potentially saved by screening younger women outweigh the health, psychological and financial costs of overdiagnosis."

"You need to screen 1,900 women in their 40s for 10 years in order to prevent one death from breast cancer, and in the process you will have generated more than 1,000 false-positive screens and all the overtreatment they entail. This doesn't make sense. We could do more research and hold more consensus conferences. I suspect it would confirm the data we already have. But history suggests it would never be enough to convince many people that we are screening too much."

I started yearly mammos at 40 .. at 46, I had a stereotactic biopsy. Because of diligent screening, my IDC was found early stage at age 51. That's a 5-year gap, not 10.

What bothers me is the defense that more focus needs to be put on better screening tools .. but what those on the committee and other doctors haven't said .. is where those research dollars are coming from ... are they going to use all the money they saved on those 1,900 mammos.

Tender .. I sure hope you sent your note to Dr. Aronowitz.

Colette37 · November 2009

BinVA...How do you send a note to Dr. Aronowitz? I think they would like to hear from me specifically because of THEIR recommendations and because a new GYN followed THEIR recommendations, I was refused a mammogram at 35 even though my mother had breast cancer at a young age and was told to wait till I was 40. Because of their actions, and an idiot GYN, I lost 2 years on my cancer and was close to it becoming mets. I am a PERFECT example of what the USPSTF will do to our families and how they are the "Panels" (Their terminology, not mine) that will end up deciding what will be paid for and what wont will be paid for via the government ran health care.

Bren-2007 · November 2009

Robert A. Aronowitz, M.D. Professor

University of Pennsylvania
Department of History and Sociology of Science
Claudia Cohen Hall, 249 S. 36th Street
Philadelphia, PA 19104-6304
Telephone: (215) 898-5621
E-mail

M.D., Yale University School of Medicine
Graduate Study in Linguistics, University of California, Berkeley
M.A., Columbia University, Teachers College
B.A., University of Michigan

Area of Specialization:
History of 20th century disease, epidemiology, population health.

Books:

Unnatural History: Breast Cancer and American Society, (Cambridge University Press, 2007)

Making Sense of Illness: Science, Society, and Disease. Cambridge University Press, Cambridge, U.K. and New York, 1998.

Robert A. Aronowitz studied linguistics before receiving his M.D. from Yale. After finishing residency in Internal Medicine, he received training in the history of medicine as a Robert Wood Johnson Foundation Clinical Scholar. Dr. Aronowitz taught at the Robert Wood Johnson Medical School and practiced medicine at Cooper Hospital before arriving at Penn in 1999. At Penn, Dr. Aronowitz was the founding director of the health and societies program. He also co-directs Penn's Robert Wood Johnson Health and Society Scholars Program, an innovative post-doctoral and research program focused on population health. Dr. Aronowitz's first book, Making Sense of Illness: Science, Society, and Disease (Cambridge 1998) explores changing disease definitions and meanings in the 20th century. His second book, Unnatural History: Breast Cancer and American Society (Cambridge, 2007) is a history of breast cancer in American society since the early 19th century, with special attention to patient and doctor decision making and the experience of disease and risk. He is currently in the midst of a project on the history of health risks in American medicine and society, for which he was the recipient of an Investigator Award in Health Policy from the Robert Wood Johnson Foundation.

EDITED: You can read the intro to his book Unnatural History: .... here http://www.amazon.com/reader/0521822491?_encoding=UTF8&ref_=sib%5Fdp%5Fpop%5Ftoc&page=8#reader_0521822491

Colette37 · November 2009

Thank you so much!

RunswithScissors · November 2009

Collette-

"Panels" are not a new concept. Frankly, "panels" of experts have compiled almost every aspect of our past and current medical system. They review and revise policies and treatments everyday. How else could doctors make adjustments and advances based on new information, technology, and studies?

To the OP, Swimangel - the op ed sounds to me like the opinion of a person who is well versed in the history of cancer treatment. Conversely, your post makes speculative and personal attacks against him. In addition, you incorrectly quoted him as saying "treatments...created a culture of fear."

Maybe you should have a cup of coffee and rethink your post. He doesn't come across as the illogical one to me.

Edited to clarify "OP"

Colette37 · November 2009

Pill, and if I wouldn't have stated that it was their term, I would have been accused of causing "Right wing" chaos...Which is ironic, because I am not a republican, but a mother who wants to make sure my daughter has every chance at early detection if she ever has breast cancer.

What sounds illogical to me is giving this massive amount of power to the USPSTF who does not have a clue as to what they are doing by taking away all methods for young women to fight breast cancer.

You weren't the one that would have been saved from young women getting care were you?

AnnNYC · November 2009

Robert Aronowitz wrote the editorial, "Addicted to Mammograms," but he is not a member of the USPSTF.

The Vice Chairwoman of the USPSTF is Diana Petitti -- here is her faculty bio page from the University of Arizona:
http://sci.asu.edu/directory/page.php?profile=794

and her email address: diana.petitti@asu.edu

The Chairman (who I haven't seen available for comment in the press!!!!) is Ned Calonge:
http://www.cdphe.state.co.us/calonge/Calongebio.html

email: ned.calonge@state.co.us

orange1 · November 2009

Re: Cost of MRIs -

The auto industry used to claim they couldn't put air bags in cars because the cost was prohibitive. Then congress mandated that they be available, and the auto industry figured out how to do it economically. They same will happen for MRIs if there is a driving force to change current practice.

orange1 · November 2009

Re: Cost of MRIs -

The auto industry used to claim they couldn't put air bags in cars because the cost was prohibitive. Then congress mandated that they be available, and the auto industry figured out how to do it economically. They same will happen for MRIs if there is a driving force to change current practice.

swimangel72 · November 2009

Thanks Pill for pointing out my incorrect quote - yes, I did sit down this morning, had a cup of coffee, re-read this doctor's article - and everyone's comments - and must admit you are right.. I edited my opening comments. I did make "speculative" claims that were a result of my frustration with everything that's going on with the new guidelines. However, I forgive myself for this (as I hope you will) because of all I've suffered as a result of breast cancer. Still - to read an article written by an internist/historian does not make the issue of the new guidelines any easier to accept. As I wrote on another thread............I am hopeful however that SOMETHING good will come from this firestorm - the attention being shown to breast cancer and the fact that we have not made much progress in reducing the deaths from this dreadful disease is good.........and hopefully the money we have all donated to a cure will be directed towards finding safer and more accurate diagnostic tools for detecting bc in young women. I totally agree with you Orange - as my mother always says, "have to is a hard master" - and cheaper and safer MRI's would be such a fantastic solusion - I pray this will happen soon for my two 20-something year old daughters - and all young women to follow - not for myself.

Colette37 · November 2009

Orange...MRIs will not catch all breast cancer tumors. They usually don't detect DCIS which is why they are used together with mammogram when a lump is detected.

TenderIsOurMight · November 2009

Orange, I agree with your thoughts about driving force and supply and demand. Clearly the supply side needs to increase to reduce cost per MRI, driven by approved demand. Colette, yes, currently MRI's are used in tandem with mammograms. I was discussing MRI's as a screening tool alone in the future if breast MRI can be further tweaked even more on it's sensitivity and specificity.

Here are a few full linked articles which may help put MRI's in perspective:

Cost-Effective Screening for Breast Cancer Worldwide: Current State and Future Directions

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613364/?tool=pubmed

Mammography

Mammography provides X-ray images of the breasts with at least two sets of images, the mediolateral oblique and cranial-caudal views. A recent large-scale clinical study (42,760 patients in U.S.A. and Canada) on the diagnostic performance of mammography for breast-cancer screening demonstrated a sensitivity of 70.0%, specificity of 92.0%, and diagnostic accuracy interpreted as AUC of 78.0%[4]. The European randomized mammography screening trial (23,929 patients in Norway) revealed a sensitivity of 77.4% and specificity of 96.5% at full-field digital mammography. The median size of screening-detected invasive cancers was about 13.5 mm[19]. In the United States, despite the recommendation for an annual mammogram, in 2005 only 47.8% of women aged 40–49 years had a mammogram within the past year. Among the women without health insurance coverage this value decreases to 24.1% [10]. The cost-effectiveness screening film mammography are estimated as 902–1,946 USD per year of life saved in India, 2,450–14,790 USD per year of life saved in Europe, and 28,600–47,900 USD per year of life saved in U.S.A.[6]. Among the limitations of mammography are increased breast density, technical factors, e.g. areas adjacent to the chest wall may not be imaged[20], lack of insurance coverage, disagreements among primary care physicians on frequency of mammographic screening, variation in interpretation skills of radiologists.

The mean glandular radiation dose from 2-view mammography is approximately 4 to 5 mGy and the dosage varies among facilities and increases with breast density. The average cumulative exposure from screening during the decade will be around 60 mGy[70]. There is a strong linear trend of increasing risk of radiation-induced breast cancer with increasing radiation dose (P = 0.0001) [71]. A statistically significant increase in the incidence of breast cancer following radiation treatment of various benign breast diseases was observed[72]. Several recent studies suggesting that carriers of pathogenic alleles in DNA repair and damage recognition genes may have an increased risk of breast cancer following exposure to ionizing radiation, even at low doses[73]. Based on review of 117 studies related to screening mammography the authors concluded that “the risk for death due to breast cancer from the radiation exposure involved in mammography screening is small and is outweighed by a reduction in breast cancer mortality rates from early detection.”[74].

MRI

MRI utilizes magnetic fields to produce detailed cross-sectional images of the breast tissue. Image contrast between tissues in the breast (fat, glandular tissue, lesions, etc.) depends on the mobility and magnetic environment of the hydrogen atoms in water and fat that contribute to the measured signal that determines the brightness of tissues in the image. Many indications for clinical breast MRI are recognized, including resolving findings on mammography and staging of breast cancer[22]. Overall, the results of 6 nonrandomized prospective studies in the Netherlands[24], the United Kingdom[25], Canada[26], Germany[27], the United States[28], and Italy[29] of MRI efficacy in breast cancer screening for high risk women populations demonstrate an averaged sensitivity of 87.5% and specificity of 92.8%. Only limited data are available on the cost effectiveness of breast MRI screening being combined with mammography. The cost per quality-adjusted life year saved for annual MRI plus film mammography, compared with annual film mammography alone, varied by age and other factors to be found in the range of 27,544–130,420 USD. The reimbursement for bilateral MRI diagnostic procedures was 1,037 USD according to 2005 U.S. average Medicare reimbursements, which is about eight times higher than the screening mammography[5] and out of pocket charges by private clinics are as much as 5 times higher.

American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography

CA Cancer J Clin 2007; 57:75-89

http://caonline.amcancersoc.org/cgi/content/full/57/2/75

Limitations of Evidence from MRI Studies and Research Needs

"Although the literature shows very good evidence for greatersensitivity of MRI than mammography and good evidence for astage shift toward earlier, more favorable tumor stages by MRIin defined groups of women at increased risk, there are stillno data on recurrence or survival rates, and therefore, lead-timebias is still a concern. Further, a large randomized, mortalityendpoint study is unlikely to take place, and it will be necessaryin the foreseeable future to rely on evidence of stage of diseaseand types of cancers. In the absence of randomized trials, recurrenceand survival data will come from observational study designs."

CONCLUSION

Select Paragraph (1 of 3): "Several studies have demonstrated the ability of MRI screeningto detect cancer with early-stage tumors that are associatedwith better outcomes. While survival or mortality data are notavailable, MRI has higher sensitivity and finds smaller tumors,compared with mammography, and the types of cancers found withMRI are the types that contribute to reduced mortality. It isreasonable to extrapolate that detection of noninvasive (DCIS)and small invasive cancers will lead to mortality benefit."

There is hope.

Tender

Blundin2005 · November 2009

Tender -- Thanks .... and thanks.

Best wishes to all as always,

Marilyn

otter · November 2009

I apologize to those of you who've seen my other posts offering this link. It's an article in the Huffington Post, but it isn't "political" at all. It argues that the USPSTF ought to have anticipated the reaction to its new recommendations, and that the recommendations might be resurrected once the anger calms down and people go back to their regular programming. Have a look:

What Happens When The Anger Subsides? -- The New Breast Cancer Guidelines

otter

iodine · November 2009

part of that good article (thank you for posting it) is one of my concerns: what happens when it is old news? We have seen too many things accomplished in the dark or under wraps when no one was watching.

swimangel72 · November 2009

Great article Otter - thanks for posting the link! I especially like the following:

I've yet to meet one woman who has said, "Spare me the anxiety. I love these guidelines. I can go about my life now free of worry about cancer until age fifty and then only every other year?" Women aren't that stupid.

And this paragraph as well speaks clearly:

This report should stand as a lesson in health communication and in the caution required of responsible health professionals when what's at stake is life -- not just a number on a page -- but rather a mother, sister, aunt, daughter, cousin, colleague or friend. Surely we can do better for them.

My ob/gyn, pcp, and oncologists all belong to the same group practice. They have issued the following statement on their home pag, which is very reassuring to me!

We continue to recommend annual digital mammography starting at age 40 as also recommended by the American College of Obstetrics & Gynecology, the American Cancer Society, the American College of Breast Surgeons, and the American College of Radiology.

Even the studies cited by the United States Preventive Services Task Force (which advocates starting mammography at age 50) still show up to a 15% reduction in deaths if women initiate regular mammography at age 40. It is likely that digital mammography would have produced even greater improvement.

We are concerned about the worry created by false positives (abnormalities and biopsies which are normal). We continuously monitor our results and strive to meet national guidelines for this. In addition, we have been recognized as a Breast Cancer Imaging Center of Excellence by the American College of Radiology.

Colette37 · November 2009

Otter that is exactly what I am worried about. I am not worried about myself, because I have a big red "C" on my forehead...I am worried about my nieces, daughter and friends.

I also have had first hand experience to what a new Gyn fresh out of college reaction to the USPSTF because it is based on their recommendations about the staunch 40+ for the reason why I did not get a mammogram at 35 even when I pointed out my mother having breast cancer at a young age. Why do I think the USPSTF had something to do with it? Because it was government health care and she gave me the air that she shouldn't do anything extra. She even said I should stop getting pap smears close together even after having a LEEP procedure done a few years before seeing her.

We have to say NO! To this bill, and there by squashing the USPSTFs power over our insurances. If we don't our insurances will be following the USPSTF based on LAWS which they don't have as of yet...but will soon if this monster goes through.

AnnNYC · November 2009

Thanks for the link, Otter.

The whole essay was great -- I especially liked this:

The reasons for such recommended changes should be conveyed to the public with extraordinary attention to clear and accurate communication as well as sensitivity. They were not.

And ironically, for all the talk about protecting women from anxiety by starting routine screening mammography later and doing away with training in BSE, the recommendations derived from the USPSTF report created a maelstrom of fear and concern.

Colette37 · November 2009

Ann...it is as if they are saying "Since mammograms are so scary, we just wont say that you have one, then that will solve everything!"

Alaina · November 2009

Thanks for the link Otter.

My issue isn't with the report. Statistically and scientifically, I believe the report was sound.

My issue is with the media and how the report was reported. Maybe there was no "good" way to deliver politcally incorrect information, but surely something HAD to be better than having thousands upon millions of women nationwide believing they would never be allowed to have a mammogram again until they turned 50. And having thousands upon millions of women believing that no matter WHAT their symptoms were, doctors and insurance companies were going to leave them to die with aggressive growing cancers just because they were too young for a mammo. THIS is what caused the eruption of outrage. The report recommended NONE of that, in fact, the report didn't refer to diagnostic mammos at all.

Now my sphere of influence and small world view may not be (and isn't) "statistically significant" but yet and still, of ALL the age 50 and under breast cancer stories I've read about or witnessed personally, only a very small percentage of them were found by "routine screening mammograms." The vast majority of them were found because a woman felt a lump and/or had some other symptom, and the doctor ordered a DIAGNOSTIC MAMMOGRAM. Diagnostic mammograms can be obtained at ANY AGE and covered by insurance with the correct coding.

My personal opinion is that if the money saved by not doing regular screening mammograms of women who don't really need them (ie: they are having NO SYMPTOMS and have no strong family history), can be re-directed into finding better more accurate screening methods for young(er) women, and/or hmmm....let's consider this, A CURE, then I'm all for the recommendations.

But this hue and cry is mostly the media's fault. They made sensational "news" out of something doctors and cancer specialists have known for years...by scaring people into believing mammograms would no longer be available to them if they were under the age of 50. This is an outright lie and total misrepresentation of the report. But thanks to the media, this is what most women now believe.

Colette37 · November 2009

Alaina...This is a question, not ment to taunt you, just a question. You have never worked for the government have you? The government reads the standards as this is what you do and no more. In the effort of cost cutting, which testing has proved will go first? Cancer testing because if a person is not diagnosed with cancer then they don't have to spend the money to treat them.

I don't know how many times that I can say this, but I experianced these recommendations FIRST HAND when I turned 35 through a government employed GYN...the standard was for women 40+ and the GYN told me to wait till then. NOW, at 37, I had a 10 cm tumor of slow growing DCIS that was removed after being diagnosed with IDC and chemo. There will be more and more women that will be diagnosed like me...which I had to go through my husbands private insurance to get diagnosed and treatment.

I am not standing of for myself..I already have a bit red "C"...I am standing up for my daughter and friends.

EDIT: It SHOULD have read: I am not standing up for myself...I already have a big red "C" on my forehead...I am standing up for my daughter and friends.

lewing · November 2009

Alaina, thanks for your thoughtful post.

Linda

Alaina · November 2009

Hi Colette. As a matter of fact, I am a 21 year federal government employee. I am an academically and professionally trained Mathematical Statistician (Masters in Applied Math from Johns Hopkins, and one year of doctoral course work at Hopkins in Biostatistics). For the last 3 years, I've been in upper-level management with the feds.

I am not ready to buy into the emotionally-wracked conspiracy theories that doctors, feds, panels, and others are going to let young women die on their doorsteps because of these guidelines.

You and I have identical Diagnosis Markers. Did you have symptoms? I did, a rash and a swollen lymph node. My dermatologist dismissed my rash as hives (from an antibiotic I had been taking). Thank God my primary care didn't believe him. She ordered a diagnostic mammogram that found a DCIS forming. She also ordered a sonogram of my lymph node. It was 3cm (pathologic in size, and after a fine-needle aspiration, confirmed cancerous). My 2 tumors never showed up on the mammo, but the docs knew something had to be in that breast because the DCIS could not have caused the cancer in the lymph node. An MRI confirmed 2 tumors (8.5cm and 6cm, flat, fast-growing, and poorly-differentiated).

All of this was found due to diagnostic tools to root out what was causing my SYMPTOMS. I'd never had a routine screening mammo, and in my case, it would not have helped. My symptoms showed up literally overnight.

If a woman, of ANY age, has a doctor who is dismissive of her SYMPTOMS, she needs to get a new doctor.

But a routine screening mammogram didn't save my life, nor the lives of many of the young(er) women I know with breast cancer. A diagnostic mammo played a role, leading to other methods for confirmation. The new guidelines would not have changed how this played out in my life, nor theirs.

New York Times "Addicted to Mammograms"

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American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography

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