ACS says mammos should start age 45 and not 40 now...
http://sanfrancisco.cbslocal.com/2015/10/20/americ...
IMO this is the stupidest thing. How many below 40 get breast cancer??? And you are saying to not worry about mammo until 45??? Am I missing something here??
Comments
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I'm not sure what to think. I found my own lump on the right but the left was found on mammo. My OB said no need for mammo 'til 50 as I had no family history or major risk factors, that was last year. Fast forward to this May.....I have bilateral BC at 41 - she cried when I saw her in last month and told me she has changed to 40 for everyone and 35 for higher risks - they keep saying young women have such a low risk but there's plenty of very young women here on BC.org
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My response to the new recommendation is a common barnyard epithet that is not allowed to be posted here.
I think they're being far too statistics-driven and not seeing the forest for the trees. I got my first mammo as a baseline at 38--I'm 64 now, with no family hx and tested BRCA-negative. My PCP mentioned that at the AAFP convention last summer they were talking about starting annual mammos at 40 instead of 50 resulting in only a negligible increase in overall survival (or “decrease in mortality from all causes"). Well, IMHO there's a big difference between dying in your sleep in your 80s or 90s of a heart attack and the process of dying from terminal cancer (sorry to upset anyone here going through that). And “all causes" also included non-natural causes such as accidents and homicide. In my case, starting my mammos early gave me reassurance at first; and then later on provided perspective against which to judge each successive year--culminating in having discovered my cancer as an anomaly that wasn't present last year.
I had two friends diagnosed in their late 20s. One died within a couple of years because mammograms were not yet available and her cancer was first diagnosed well into Stage IV; but the other lived into her early 40s precisely because she began getting mammos at 25 due to having fibrocystic breasts. She also had a very aggressive cancer (this was in the days pre-BRCA testing, but she had extensive family hx of premenopausal breast and ovarian cancer and, like me, was Ashkenazi on both sides; so she was very likely BRCA-1 and/or -2 positive), but catching it from the beginning gave her 13 years to see her daughters “launched" into young adulthood.
Yes, there are false positives involved in testing--but what if you decide you don't want to go through the emotional hassle of a possible false positive and stressful and possibly invasive testing.........and YOU end up among the relatively rare women who miss detecting an actual cancer until it's no longer curable? Better safe--albeit scared and scarred--than sorry.
Relative risk is meaningless, IMHO. As Susan Love puts it, statistics be hanged--whatever happens to you is 100%.
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I'm a statistics driven person and the statistics line up with the recommendations so I agree with them.
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The other part of their report says that after 55 women should only have mammograms every 2 years instead of every year. If that were the case, I'm thinking I would possibly have been at stage 4 at diagnosis, as opposed to stage 3a.
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Personally, I think the ACS should advocate for better screening methods for younger women (in other words, those more likely to have dense breasts that hide BC on mammo screenings.) A better method of detection would also lower the number of false positives.
The new recomendations just take away methods of detection for younger women, and put nothing in its place. ACS moved to limit mammograms for women under 45 and, in the same breath, recommended against clinical breast exams. So, what do the younger women have left?
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Oh! That's almost like a riddle...
Q: What's left for women under 45, under the new ACS recommendations?
A: Next of Kin.
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I'm 31 with no family history and no risk factors. I also know that I had a .04% chance of having breast cancer. I understand statistic driven data and science backed research, but it's still hard to read.
My husband actually found my lump (thank you DH for being a "thorough" explorer!) and my PCP, along with everyone else, was so sure it would be nothing. My PCP still sent me for a mammogram but when I got there I had to argue with the technician about actually getting one. She repeatedly told me I was too young even though I had a palpable lump. It was only after they called my doctor that they would even proceed.
What's hard is that the science says risk-wise, those few of us in the smallest percentage will slip through the cracks and are not worth the cost of early detection and extra biopsies. I get it, but it's putting a direct value on my life and other women like me.
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I think the ACS should educate doctors, so they take lumps in young women seriously and do the appropriate diagnostic tests. I get tired of reading about young women who go to the doctors because they felt a lump and they get told they are too young to have breast cancer. That said, I do think the new guidelines aren't that big of a deal. While they more closely reflect the recommendations of the USPSTF and the screening practices in other countries, the recommendations aren't rigid and will tend to encourage discussion between women and their doctors. I think we would all be better off if screening was individualized and reflects a woman's risk for developing breast cancer.
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A link to one of the better articles I've read, addressing the harms and benefits screening mammograms:
http://fivethirtyeight.com/features/science-wont-settle-the-mammogram-debate/ -
I'm pretty sure that I'm one of the women they're trying to screen out. I was 42 at diagnosis. I was told me it was stage 0, or DCIS, but that it would need to be removed. When the area was removed there was an area of IDC buried in the DCIS. If I hadn't had surgery, I would have been diagnosed much later, as well.
I'm sure the statistics line up, but I agree with MissBee...it seems like they're saying I'm part of a low-risk group but that low risk translates to lives (like mine).
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i was 42 when diagnosed, wasn't being screened either b/c here in Canada screening routinely starts at 50 HOWEVER you can get screened earlier if you and your doctor would like to start earlier. They are guidelines not hard and fast rules.
I agree with lisa-e Where us young women fall through the cracks is not being taken seriously leading to later diagnosis. How many of us have been told "there is no way, you are too young for BC"
I had a fibroadenoma removed in my 20's, while common, I should have been watched more carefully because I already had a benign mass removed - apparently it does put you at higher risk (your boob likes to grow things?) I did ask for a mammo but was denied - funny thing is the mammo after I found the lump did not show up,I would have need a ultrasound or mri. Which is exactly the next point mentioned...our young group needs better screening!
I don't really have an issue with the age per se...more of the education surrounding screening, better screening if it is determined you need it and more awareness that young women get BC
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Bad enough that younger women with BC (whose cancers are usually the MOST aggressive) are discounted because they are statistically outliers! ("Sorry, but we're only going to play the odds here, so your life doesn't count as much"). But what I find incredible is the ACS recommendation that annual mammograms should be only from 45-55, and biennially thereafter! Oh, really? What about the fact that the average age at diagnosis is 60? Or that a woman's risk rises beginning at menopause? My most recent screening mammos were 2013, 2014, and 2015. (Age 62, 63, and 64). What if my doctors and insurer said this past August “Sorry, but you had a mammo last year, and you're not due for another one until next summer?" That 1.3cm IDC they found in August was NOT on my whistle-clean 2013 & 2014 mammos. In one year it went from “not there" to over a cm. How much bigger would it have been if not discovered till next year? It wasn't in my lymph nodes when they found it--heaven knows it might have spread had I spent a year blissful and clueless till next summer's mammo!
True, most women who are initially diagnosed over 55 tend to have less-agressive tumors. But “most" does not mean “all." (We may wrinkle our noses at rich celeb patients like Joan Lunden, but she was diagnosed at 61 with triple-negative BC--hardly “less-aggressive"). The ACS is crunching numbers and compiling statistics, not dealing with actual patients and breast surgeons & oncologists “in the trenches" such as Susan Love or Elisa Port. Not surprisingly, these two surgeons vehemently disagree with the ACS' recommendations (which seem to be a Solomonic “split-the-baby" compromise between some recommendations for annual mammograms to begin at 40 and others at 50). But this “okay to go biennial after 55" business is truly cockamamie.
Yes, it is not statistically common for women under 40 to get breast cancer, and perhaps it is equally uncommon for older postmenopausal women to get aggressive tumors. But it still happens--often enough to be in the tens of thousands per year. It isn't enough to say “too bad you got an aggressive cancer when you weren't statistically supposed to, but life isn't fair, that's the way the cookie crumbles, let it go."
Bullshit. (there, I said it, even in asterisks). The truth is that since civilizations began, a society is measured by how it treats the least among it. (I think there was a guy in my ethnic group around 2,000 years ago, give or take a decade, who said “what you do to the least among us you do to me"). “The least" among us isn't limited to the poorest and most disabled. It also has to include the statistical outliers. Because as I said in an earlier post, it doesn't matter if you had only a 5% chance of getting cancer--if it happens to you, it's 100%. And the fact that it wasn't statistically “supposed to happen" doesn't make it any less painful or burdensome.
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Thank you, ChiSandy. I couldn't agree more and you've stated the case beautifully.
I will add that I was one who had switched to following the joint task force's recommendation for biennial screening - and my cancer, though not large, was in my nodes when it was found. Needless to say, I'd much rather have found it earlier.
There's a lot of talk about how women should make the decision in consultation with their doctors - well, that assumes that one's primary or ob/gyn has time and interest and knowledge to help one make an informed decision. Mine never bothered to inform me that my breasts were still dense, brushed aside the family members with cancer because they weren't first degree, and generally led me down the primrose path. Bad as that situation was, I doubt I'm the only one whose PCP has been too busy or disinterested to provide guidance through the recommendations.
I'm appalled at the ACS and will call them tomorrow if I've calmed down enough by then.
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I just read that fivethirtyeight.com article. (fivethirtyeight.com was started by Nate Silver to predict presidential elections based on a bunch of arcane variables, and has devolved into a handicapping site for everything from sports betting to who will get bumped off “American Idol" every week). The author, with the callow arrogance of youth and unshakeable faith in arithmetic, sneers at those who ignore statistical “evidence" in favor of “values." She claims evidence of the various models shows a net saving of 4-10 lives per 1000 women screened, and dismisses the desire to save that statistically insignificant number of lives as a mere “value."
First of all, as to the agony of “false positives," nobody ever died from anxiety over a suspicious mammogram that turned out to be benign. (And talk about relative “values," which is the bigger tragedy: a woman having to undergo what was IN RETROSPECT an “unnecessary" needle biopsy or a woman who dies because her doctors--or worse, some bureaucratic layman bean counters--crunch the numbers and erroneously reassure her she has no need for testing and she believes them)? Listen, if my core needle biopsy had turned out benign would I have been pissed off that I had been put through all that worry (and in the general scheme of things, a minimally-invasive and barely uncomfortable procedure) for “nothing?" Hell no--I would have thanked my lucky stars that everything turned out okay--just as I thank heaven that those expensive Oncotype DX and BRCA test results turned out to be favorable rather than worrisome. What's next--wanting to spare women the discomfort and embarrassment of having to get their breasts smooshed between glass plates in front of a total stranger? Oh, the horror!
So annual screening “saves" only 4-10 lives out of 1000 women? What if the tables were turned and society “found" statistics that showed culling 4-10 people per year from the population eases expenses and drains on natural resources? We'd certainly be outraged by that. A living breathing sentient adult woman--of whatever age, societal role, marital status or number of kids--is a LIFE. A priceless life. It HAS to be priceless--otherwise, we have no humanity left.
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I almost skipped my mammogram last year due to the changing of guidelines about whether we should have mammograms annually or bi- annually. Thank God I went anyway. ACS is looking at survival rates alone and not other factors. My 5 year survival rate might have been the same if I hadn't found the Cancer for another year, but I might have needed a MX or harsher chemo treatment and suffered more.
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Very good points have been raised about how we are to detect BC in young women. I'm sorry that so many weren't taken seriously when they had symptoms at a young age. When I was 29 (and pregnant) I found a lump in my left breast. I had an ob appointment that week so I mentioned it at the end of my appointment. My doctor was a bit shocked that I waited until the very end of the appointment to tell her AND that I was pretty unconcerned about it. Because I was pregnant I was scheduled for an ultrasound instead of a mammogram, and they made sure to get me in right away. No one questioned the need to check it out. This was early 1999. (It turned out to be a simple cyst.)
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And here is our take on it:
Breastcancer.org stands by its recommendation that ALL women have #mammograms annually starting at age 40
Read more here BCO ACS Guidelines for Mammograms
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Maybe this would all be a mute point if we would find the CURE!
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According to lifestyle and family history, I had very little risk of breast cancer. If today's guidelines were in place and insurance fought diagnostic methods (clinical exam and imaging), I would not have received diagnosis or treatment even though I already had positive nodes...
The recommendation against all clinical breast exams shocks me -- I had dense breasts with lobular carcinoma in both breasts not seen on mammogram (... age 52) My PCP felt the thickening in my right breast and ordered an ultrasound... carcinoma in other breast found on prophylactic MX. (I had mammograms, ultrasound, and MRI on the prophylactic breast...) why oppose clinical exams? It costs little (a few minutes) and saved my life. New guidelines say no evidence of saving lives? How would they know this? Lobular (1 in 8-10 breast cancers) does not usually form a distinct tumor. I did self-exams but have always had lumpy breasts -- thought that cancer would be more pea-like? Lobular often grows slowly... I did not notice the change... My PCP very clearly felt the difference. I think insurance companies have the industry by the b*lls, so to speak... And limited resources and insurance constraints keep us from getting follow-up scans as well. If they find more cancer, insurance companies incur the cost of treatment...
I feel men get better treatment as well. My brother-in-law gets awesome MO care and follow-up for prostate cancer at the same academic center where I see a NP most visits, who even ordered the wrong treatment for me on my last visit... I wait for hours and then everything is rushed. I was told by a patient advocate that I am responsible for making sure that I get the right treatment! "Sorry that you felt" that you did not receive the best care... I wish that they honestly cared to discuss the concerns and possible solutions. Zoladex and Zometa are significantly different drugs... Since I had an oophorectomy, I would not benefit at all from Zoladex... Don't patronize me. My BIL even gets coupons for breakfast on the prostate floor! On the BC floor, I feel like one of a herd. My sister even noticed the difference when she came to my appointment... I have become cynical, for sure. Why are we not offered immunotherapy? It saved my BIL's life. They just keep suppressing our immune systems... Where is the lab test that indicates BC?
There are just too many of us, and our numbers are increasing. Not good for the insurance companies... The cancer industry is very complicated...
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You know our stance on the new ACS guidelines and we heard what you had to say.
Help us mobilize the entire breast cancer community around this "For 40" Campaign -- sign our Pictition with your Facebook photo if you believe women deserve a mammogram at 40. Don't wait, it could be too late. #40SavesLives
http://pictition.com/BCO40 -
Mods, I think the 40SavesLives campaign is great - but I am just as concerned about the recommendation that women consider moving to every-other-year screening at age 55. I hope that issue won't be lost in all the discussion of the changes for those who are younger.
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I'm just as concerned about the every other year at age 55 recommendations as well. My sister has dense breast tissue. She missed a mammogram and ended up Stage 3C by missing one mammogram. If something is missed at one mammogram, that means a 4 year window.
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I'm a little confused by this new recommendation. All I see and hear is that mammograms save lives but we want to delay getting them or switch to every other year? I was diagnosed at 41. Unfortunately I delayed my mammo because it was inconvenient at the time (had one at 36-37 due to breast changes). There isn't a family history or risk factors for me so I wasn't worried about being a little late. Can you imagine how bad it would be if I waited four more years
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^^^^^ And that's why these new recommendations are the worst! They are trying to save $ because now such screenings are free for us. Boils the blood that they are saying this and going to cause more women to be diagnosed at later stages, or worse... :X
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