Seminar clarifies cancer guidelines

Feb. 25, 2010, 1:01 a.m.

Traditional cancer prevention campaigns stress that regular screening and early detection are key to survival, so when the U.S. Preventative Task Force (USPTF) changed its breast cancer screening guidelines last November to recommend less frequent screenings for women, controversy and confusion quickly arose.

To explain what these recommendations mean and correct common misunderstandings about the changes, Stanford Cancer Center and Stanford Hospitals & Clinics invited the public to a seminar entitled “Controversies In Women’s Cancer Screening” held Wednesday night. Moderated by gynecology Prof. Jonathan Berek, the seminar featured two experts on breast cancer.

“It was something that a group of us had been talking about since the [USPTF] modified their recommendations,” said panelist Robert Carlson, professor of oncology at Stanford Medical Center. “Many of us just thought it would be helpful to try to provide a more balanced perspective in what we thought we were hearing around us.”

USPTF now recommends that women over the age of 50, who are not at high risk of developing breast cancer, undergo mammogram screening every other year, instead of the previous recommendation of yearly screening starting at age 40. Other recommendations include stopping the practice of teaching women to self-exam their breasts.

One reason for postponing the start of regular screening is the fact that younger women have more dense breast tissue, making it difficult for radiologists and doctors to spot the cancer, said Debra Ikeda, professor of diagnostic radiology. The dense tissue can also lead to false positives, causing patients to undergo unnecessary and often painful and expensive follow-up biopsies.

Biopsies carry the risk of infection, bleeding, scars, distortion of the appearance of the breast and defects in the contour of the breast. Many biopsies also require general anesthesia, which has its own associated risks.

The new guidelines also recommend that physicians stop teaching women how to self-exam their breasts to check for cancer because studies show that self-exams often do not make a difference in treatment. While these examinations do not directly harm patients, this practice also has unseen negative consequences.

“Any time we have a health care professional realizing they have a limited amount of time with a patient talking about things that turn out not to matter, you can’t talk about things that do matter,” Carlson said. “You can’t talk about diet, you can’t talk about smoking cessation, you can’t talk about exercise.”

The Bay Area has the second-highest incidence of breast cancer in any of the major metropolitan areas in the U.S., and the majority of the attendees Wednesday were women, many of whom are breast cancer survivors or have loved ones who had breast cancer. Many of them expressed outrage at the new guidelines.

“It’s insane,” said Lisa Skagg, a community member. “Early detection saves lives. I have two friends who’ve had cancer in their 30s. It’s not just the mammograms, it’s the no self-checking. How is anybody before 50 ever going to find out they have cancer?”

“I think it’s dangerous,” said Marina Chudnovskaya, a breast cancer survivor who was diagnosed at the age of 44. “I had no risk factors, none of them<\p>.<\p>.<\p>.<\p>so according to these new guidelines I would have not been screened or just recommended for screening until the age of 50.”

Chudnovskaya said she was diagnosed “only by chance” at her routine yearly mammogram. She said that had she waited another six years, she “would probably be dead by then.”

Katherine Fuh, an oncology fellow at UCSF and Stanford, has a different take on the issue.

“I think that the data support the recommendation,” she said.

She noted that a conflict, however, will exist between the research conclusions.

“I think that it’s always ingrained in us to do a Pap smear every year or do mammograms more frequently than not, so I think that there’s just going to be a conflict between knowing what this data in the research show versus what you’re used to doing and telling your patients for many years,” she continued.

While doctors are not mandated to follow these guidelines, many insurance companies base their policies off of USPTF guidelines, which can make it difficult for women whose doctors recommend annual screening before the age of 50.

“It’s a social issue and a public health issue that’s very important that we address in our society,” Berek said.

Despite the consensus among the speakers, the medical community remains split between the two guidelines.

“It’s critical that we study it more and we study it better,” Berek said. “It’s not over yet.”

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