Published: November 23, 2009 08:31 am      

Breast cancer guidelines scorned

The bewilderment local breast cancer patients, surgeons and activists felt last week after hearing a proposal to cut back on mammograms and eliminate breast self exams has turned to anger as more details are learned.

Local experts and patients join the firestorm of response to a government advisory committee’s advice to hold off on routine mammograms until age 50, instead of age 40 as long-recommended by American Cancer Society.

“I think that is ridiculous,” breast cancer survivor Mary Ann Baran, 57, of Richland Township said, remembering her battle with breast cancer 11 years ago.

“If I had not gone for mine for

three more years, it would have been out of control.”

Cancer survivor Elizabeth “Betty” Krug, 48, of Northern Cambria echoed those sentiments.

“I am very, very upset about it,” Krug said. “If I had waited around to be 50 years old to have a mammogram, I’d probably be dead now.”

Krug was diagnosed with cancer two years ago after finding a lump during a breast self-exam – a practice the task force said has no value.

For nearly two decades, the cancer society has been recommending regular mammograms beginning at age 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women’s odds of surviving the disease.

The new guidelines were issued Nov. 16 by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

Local doctors said nothing should change here. Most insurance companies follow American Cancer Society screening guidelines.

“We are not changing anything with the recommendations,” Dr. Dianne Craig, breast surgeon, said from Joyce Murtha Breast Care Center at Windber Medical Center.

“Most insurance companies follow American Cancer Society guidelines,” Craig said. “They haven’t changed. They don’t agree. I don’t think there are going to be too many changes involved.”

The task force guidelines are troubling because they seem to be based on financial savings, instead of disease prevention, Dr. Gerard Garguilo said from Memorial Medical Center.

“We are back where we were 10 or 15 years ago with this whole debate,” Garguilo fumed.

“They don’t dispute the fact that routine screening for breast cancer does improve mortality. They are saying the potential for harm from the mammogram is greater for the 40-49 group. That increase harm is what is making them recommend against routine screenings.”

The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, cancer society Chief Medical Officer, Dr. Otis Brawley, said in a statement.

Although the task force considered harm caused by radiation from mammograms, that risk is quite minimal, Garguilo said, adding that the group’s primary concern focused on psychological harm from the stress of false-positives leading to unnecessary biopsies.

“In my 30-plus years of practice, I have never had a patient lay into me because the biopsy was negative,” Garguilo scoffed.

“The peace of mind that patient gets in many cases is priceless.”

“If you only catch one or two, it’s so much better,” cancer survivor Nancy Kozuch of Somerset said. “It’s affecting someone’s life.”

The advice to cut back on mammograms and eliminate self exams sends the wrong message, breast surgeon Dr. Patti Ann Stefanik of Johnstown said.

“The government is not caring about women in this country,” Stefanik said. “They are thinking with their pocketbook. They are looking at putting a financial value on these women’s lives.”

There will be no savings in the long run, she said.

“These insurance companies are going to be paying for hospice care,” she said.

Local hospitals expect no policy changes.

“It is still the decision of the woman and her physician,” said Barbara Cliff, president and chief executive officer of Windber Medical Center. “We are not going to change our recommendations.”

That’s good news to Windber patient and cancer survivor Doreen Fogle of Altoona.

“It is just ridiculous to suggest that it is unnecessary to utilize a tool that can allow early detection of breast cancer and greatly improve survival rates,” Fogle said.

It seems they are more concerned with cost than care.”

Fogle was 39 when she found a lump while doing her monthly breast self-exam. A mammogram and biopsy confirmed her fears.

She thinks routine mammograms should begin earlier, not later.

“I woke up one day feeling great,” Fogle said. “I found a lump and, suddenly, I had cancer. Thank goodness I found that lump myself, but how much better would I be if I had had a mammogram?”

Breast self-exams are crucial, Baran stressed.

“I belong to a support group,” she said. “People who come in, almost all of them find the cancer on their own.”

Scientists at Windber Research Institute said they are concerned the recommendations could discourage African American women from getting mammograms.

“The Windber Research Institute is involved in research protocols that identified tumors in young African American tend to have aggressive tumor characteristics and are associated with poor outcomes,” project director Rachel Ellsworth said.

“These recommendations are inconsistent with current science,” said Tom Kurtz, research institute president and chief executive officer.

“The fact is the death rate from breast cancer was unchanged for the 50 years prior to the onset of regular screenings in 1990. Since that time the mortality rate has decreased by 30 percent. It is apparent that the established early detection guidelines have been effective.”