When a federal task force released new, controversial recommendations last week regarding women’s breast health, doctors and patients all had something to say.

The U.S. Preventive Services Task Force released new recommendations Monday stating women should wait until they are 50 to receive mammograms, rather than the previously recommended 40, and also suggested doctor’s stop teaching women to examine their own breasts on a monthly basis.

But Cathy Long of Hamlet, a breast cancer survivor who’s been in remission for one year, and Dr. Scott Hees with Charlotte Radiology who serves FirstHealth Richmond Memorial Hospital and Scotland Memorial, said waiting is not the way to go.

The U.S. Health and Human Services Secretary Kathleen Sebelieus also said federal health guidelines regarding mammograms, have not changed based on these recommendations.

The recommendations from the task force, which exclude the small group of women who carry the gene for breast cancer, suggested women aged 50-74 should receive mammograms every two years, instead of every year, and suggested doctor’s stop teaching women to examine their breasts on a regular basis.

The task force made these recommendations arguing that tests that follow mammograms and self-breast exams often create “anxiety” for patients and that “mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.”

Dr. Timothy Jessie with Sandhills Regional Health Systems agrees to a degree, from a surgical standpoint, that testing does often lead to more, unnecessary testing.

“Under 50, the breast is more dense and harder for a mammogram to see, and it’s more likely you’ll feel something first before it’s seen,” Jessie said. “I understand mandating mammograms for 50 and up, because between 40 and 50 the breast is dense and hard to see through so you’re not getting the bang for your buck, except for people with family history or the breast cancer gene. For those you should still start at 40, or before, depending on the circumstances. But for the standard lady I think starting at 50, from the surgery side, is what we’ve been clamoring for years. The more mammograms you do, likely something will turn up that could be totally benign.”

As for the task force’s anxiety argument, Jessie said he understands that as well.

“Once you do the test and find something and the radiologist is not sure, it’s almost a slam dunk you’ll need a biopsy. A general surgeon might see it and think it’s benign, but the patient is already conditioned to be made anxious that something is in her breast and it’s not uncommon they want it out and want it out now. Tests tend to produce more tests and procedures, and if you started them later, there would be less tests.”

One argument from those who oppose these new recommendations is that if doctors put off those tests, women will be diagnosed with higher stages of the disease, which in turn are harder to treat.

“I’ve heard all the what-if’s, too, but I would say this would not lead to more incidences of women being diagnosed with more advanced forms of cancer,” Jessie said. “We hold the mammogram in high regard but it’s only about 85 percent sensitive, that’s why we add an ultrasound on top of it, that usually gets us close to 100 percent.”

But for Long who was diagnosed with breast cancer more than a year ago after having a mammogram, a mammogram is a must-have.

“I would say absolutely don’t wait because had it not been for the mammogram, I wouldn’t have known I had cancer, because I went to the doctor and had the hands-on breast exam and one month later we found out I had cancer. I had three different places in one breast. That tells me unless it grew fast, even with a self exam, you could miss it.”

Long said prior to the year she was diagnosed, she’d always been “squeamish” about performing self-breast exams and had relied on her doctor’s hands-on exam every year. Long was older when she was diagnosed with cancer, but she wasn’t in the “at-risk” category because she had no family history of breast cancer.

“I thought, ‘she does this all the time, sees lots of patients, knows what to check for,’ but she didn’t have a clue,” Long said. “And she’s not the doctor that required the mammogram. Had I not gone to another doctor, I might not be here today. That mammogram saved me. Yes I’m over 50, but that doesn’t matter. If I’m going solely on the doctor or myself I could have missed it.”

Long said following her diagnosis she began to feel the lumps in he her breast, and thinking back, she says she probably should have begun regular breast screenings in her 20s when she was diagnosed with fibroid tumors in her breasts.

“Every time I’d go to the doctor they’d say ‘well, you have lumpy breasts,’ well that’s all the more reason I should have had mammograms earlier. I stupidly relied on the physical exam for years. To say I didn’t have cancer until my 50s may be true, but I can’t imagine waiting to get screened.”

Long said she’d been to the same doctor for years and still, she missed the cancer.

“There’s no telling how long they’d been there,” she said, referring to the cancerous lumps. “Please don’t rely solely on the doctor because they can be wrong. So wrong.”

Another problem Long encountered was doctor’s wanting to do extra tests, biopsies, ultrasounds, MRI’s, etc., before having the surgery to remove the lumps.

“In the beginning they said there were two lumps and told me exactly where they were, I was diagnosed in October, had the surgery in January and when they went in they’d found three lumps. Every single test they’d done had missed it.”

The cancer had also spread to one of her lymphnodes by that time, but she thinks it wouldn’t have had doctor’s gone ahead with the surgery.

“If ever on the other breast there’s a cancerous lump, I’ll go immediately for surgery because I waited too long last time and the cancer could grow,” Long sad.

Following the release of these controversial recommendations, Dr. Hees said “As per the American Cancer Society and American College of Radiology, we will continue to do baseline screenings at 35 and annual mammograms at 40 at Richmond Memorial and Scotland Memorial Hospitals.”

Dr. Hees also had his staff research the mammograms done since 2002 and the staff found that of the women who received mammograms and were diagnosed with cancer, 16.4 percent were under the age of 50, reinforcing the need to continue the practice of yearly mammograms for women 40 and older.

While Jessie said he understands the controversy surrounding the mammograms he said he’s unsure how it will play out, but one thing’s for sure, he said women absolutely should continue to perform self-breast exams.

“It’s good to do monthly checks and know if something pops up, particularly for younger women,” Jessie said.

“It’s fully controversial and remains to be seen how it will all shake out,” Jessie said about the report. “We’ll see. With health care reform in the news, it’s certainly a driver to do things more efficiently and save money. I’m not sure it will fly. I don’t know if people will be comfortable starting at 50. I have a hard time seeing it getting much traction.”

Jessie said from the surgical standpoint he understands the rationale, but doesn’t see how it will translate.

“It will have to be up to the doctor and the patient,” he said. “And anytime there is a symptom, most insurance companies will still pay for those mammograms, (no matter what recommendations are adopted). If there are symptoms, it’s a no-brainer and that can’t change, and certainly if there’s family history.”

Jessie said with the battle for health care reform in full force, insurance companies and medical providers are looking at ways to save money and be more efficient, which is another reason for these recommendations.

“It’s very much a moving target,” Jessie said about these recommendations. “It will be interesting to see what people do with these recommendations. The next six months to a year will be very interesting.”

n Staff writer Eren Tataragasi can be reached at (910) 997-3111 ext. 19 or at etataragasi@yourdailyjournal.com.