Dr. David Frolich, radiologist in Macon
“There are points on both sides and mammography isn’t perfect. But breast cancer increases with age, and there’s enough breast cancer in women under 50 to warrant screening. Additionally, clinical breast examinations and self-exams are important tools in breast health. We’re diagnosing a lot of benign disease today — and work-ups do cause anxiety and incur additional costs. However, with modern diagnostic tools, morbidity is minimal and costs are reasonable. The sooner a tumor is detected, the better chance of a cure. It doesn’t make sense to delay screening a woman until she’s 50, and see the cancer that began at age 41, grow for nearly ten years before we find it.”
Beverly Stanley, director, Coliseum Cancer Center in Macon
“Women know their bodies, and know when something has changed. Not every breast cancer is a big, red flashing light. We don’t see a high rate of false positives here, but I’d rather err on the side of caution and have one false positive than miss one woman with cancer. Although the majority of breast cancer is found after age 50, it seems to be more aggressive before 50, with more complicated treatment. Screening should be done every year. Although most cancers are slow growers — what if they’re not and we wait two years, rather than one, to screen? I hate to think of the impact on Medicare and Medicaid patients if these guidelines lead to a reduction in screening for these women. I’m afraid the new recommendations will undermine everything we’ve been trying to teach all these years with annual mammograms. Early detection and staying on top of things is the key to saving lives.”
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Dr. Mark Lafferty, OB/GYN, Warner Robins
The new mammography guidelines put patients at risk. The cure rate for breast cancer lies in early detection and diagnosis. It’s the cornerstone of treatment, and these recommendations detract from it. I’m concerned that we’ll see a higher number of undiagnosed breast cancer cases at earlier stages, and I don’t want to take that chance. The big fear is – are these guidelines the first step in rationing care? Will insurance carriers use them to reduce or deny coverage for mammograms? I recommend a mammogram every two years beginning at age 40. But, if within a patient’s family history a woman has one first-degree family member with breast cancer (meaning a mother, father, sister, or brother), or two second-degree family members (everyone else in the family), we start a decade sooner.
Dr. Perry Wells, gynecologist in Forsyth
“I’m a little surprised by the report, but not cynical enough to believe that it’s tied to health-care cost savings. The recommendations from the task force are based on a cost/benefit analysis. Ultimately, it falls to the physician to determine if additional mammography or other diagnostic procedures are necessary, and when. I have a less aggressive approach to mammography. If there’s no family history, and no reason for screening before age 45 or 50, I wait. Although rare, there are complications with invasive procedures. In addition to the risk of infection, most complications are minor, and are associated with biopsies.”
Dr. Paul Kross, assistant professor of obstetrics/gynecology, Mercer Medical School in Macon; also maintains limited practice
“The U.S. Preventative Services Task Force bases its recommendations on cost effective statistical analysis. But breast cancer is more than a disease. It’s an emotionally impacting issue. Everyone knows someone affected by it, so the public’s response to the recommendations was understandable. We know that earlier intervention means better outcomes. In this economy, and with the ongoing health-care debate, people are heightened to the idea of rationed care. My recommendations to my patients are individualized. In general, I’ll continue to recommend a baseline mammogram at age 40 and then, depending on risks, family history, breast density, and level of concern, continued screening yearly or every other year. My job as a physician is to improve survival rates.”
Jennifer Pittard, lead mammographer, Central Georgia Diagnostics in Macon
“Women who are coming in for their annual mammograms immediately want to know what we’ve heard. They’re worried that their insurance won’t continue to pay for their yearly mammograms. Those who can’t afford it are fearful that if insurance stops paying, they’ll have to stop their annual screenings. Women often ask me about radiation levels from the mammography machine. One mammogram is the equivalent of two-and-a-half months of the natural radiation that we get every day.”
Dr. Eric Roddenberry, OB/GYN in Macon
“The recommendations by the USPSTF are not surprising given their mission, to determine what is financially reasonable from a public health perspective. Money underlies everything in medicine. One could ask, why not do a full-body MRI for each person annually? It would catch a lot of disease, but would yield a lot of false positives and wouldn’t be cost effective. In my practice, I’ll continue to suggest mammography beginning at age 40 and annually thereafter. If you can find a tumor when it’s small and treatable — why wouldn’t you?”