New mammogram guidelines raise concerns in Middle Georgia

Shelley Marshall was shocked when she learned this week that the American Cancer Society has raised the recommended age for a woman's first mammogram from 40 to 45.

Marshall was diagnosed a little more than two years ago with a particularly aggressive cancer known as triple negative breast cancer. She had her first mammogram when she was 37 and was diagnosed at age 39.

The initial discovery of Marshall's cancer didn't come from a mammogram but from a self-examination. She found a lump in her right breast.

Marshall, who lives in Macon, said she has met a lot of women under the age of 40 who have been diagnosed with breast cancer.

If she had not found the lump herself and waited to have a mammogram at 45, it would have been too late for Marshall, she said.

"Based on my personal experience, that scared me for other people," she said. "I know a lot of people who were diagnosed before they were 40. If they had waited, a lot of (them) wouldn't have made it."

Marshall's cancer was confirmed and evaluated by oncologists. Marshall had an ultrasound, needle biopsy, diagnostic mammogram and a breast MRI. She then underwent six months of chemotherapy, a double mastectomy, 33 rounds of radiation and three breast reconstruction surgeries.

But before the diagnostic tests, Marshall's primary care doctor did not feel the lump in a previous clinical breast examination. Among the new ACS guidelines is a recommendation against such clinical examinations.

"That almost scares me just as much as waiting another five years before you have your first mammogram," she said. "Maybe I don't understand the research behind it or the details behind it, but ... that definitely would concern me.

"I would never have (my doctor) not do one -- even before my diagnosis. It's such a small thing."

In addition to self and clinical exams, Marshall recommends that women pay for annual mammogram exams out-of-pocket if insurance companies begin to decline coverage until the age of 45. She said the cash price of a mammogram can be negotiated with service providers.

"Make sure you do your own self-exams. Don't get paralyzed with fear if you do think you find something," she said. "Time matters."

MEDICAL COMMUNITY WEIGHS IN

Dr. Ericha Benshoff, co-chairwoman of breast imaging at Radiology Associates of Macon, characterized the new ACS guidelines as "very unfortunate."

The American College of Radiology and other sub-speciality societies still hold to the guidelines of a base-line mammogram at age 40 and annual mammograms afterward, Benshoff said. Those guidelines are based on a number of randomized controlled trials, she noted.

"The controlled trials, the strongest type of scientific evidence you can garner, has shown a 30 to 40 percent reduction in mortality for those offered screening mammography," Benshoff said.

Benshoff said she doesn't know why the data from those trials would be abandoned "except that there's an economic undertone."

Dr. Cheryl Jones, an oncologist in the midstate, said the ACS' recommendation to raise the baseline age to 45 is "concerning."

The new recommendations are qualified by the ACS, Jones said, as for average-risk women and are not for women who may be at high risk. But many women may not understand what that means and may be high risk, even if the patients don't consider themselves high risk, she noted. Those at high risk would include women with a family history of breast cancer or who have had hormone therapy exposure, previous benign biopsies or other risk factors.

"All of that needs to be taken into account," she said.

Jones also does not favor another new ACS guideline: getting mammograms every other year starting at age 55. Previously the guideline was to get annual exams.

"The risk of developing breast cancer actually increases with age, and we certainly do want to diagnose at the earliest possible stage so that we have the best outcome and the least toxic treatments for those women," Jones said. "So I think going to every two years at 55 is also very concerning."

She recommended that women know their family and personal health history and talk openly with their physicians to determine individual risks.

"I hope that these guidelines don't put more restrictions on physicians for patients who may be at a higher risk than average for developing breast cancer and limit their access to care or to screening," Jones said.

She also characterized abandoning clinical breast exams as a "dangerous thought."

"What that's relying on is that a mammogram is a perfect test. We know mammograms will miss 10 percent, especially in women with dense breast tissue, and you need a clinical examination by a skilled physician," Jones said.

She also recommends monthly self breast examinations.

For a woman diagnosed with Stage 1 breast cancer, the long-term survival rate is 95 percent or better, compared to 70 to 85 percent for Stage II and 48 to 52 percent for Stage III, Jones said.

"Early diagnosis is truly key for women," she said.

Laura Paxton, executive director of United in Pink, a nonprofit organization that serves more than 250 families affected by breast cancer in 21 Middle Georgia counties, said she sees no benefit to the changes.

"When we actually started our organization in 2007, we catered to the young survivors because it was so predominant at that point, and we were seeing more younger women diagnosed. Now, we do see a lot of women diagnosed, but ... we're also seeing that they're not having to have as much advanced treatment (because) it's being caught so early. Several of them are not having to go through chemotherapy. Many have had lumpectomies and not had to have mastectomies."

Paxton said she's an advocate for early screenings.

"The earlier it's caught the better the treatment and the prognosis. So, if we wait, then obviously we're going to be looking at more detrimental side-effects from that," she said. "The benefit is finding it early."

Jill Vanderhoek, executive director for Susan G. Komen Central Georgia, said screenings should be based on individual risks and should be a discussion between the patient and healthcare provider.

"What we're concerned about is that if they change the guidelines, then, there may not be access to people who need the resources," Vanderhoek said. "We're not coming out to say we disagree or agree.

"We're monitoring the situation because we want to make sure that women who have risks get the resources that they need. They need to be informed on what's out there and they need to talk to their health care providers."

Telegraph writers Laura Corley and Andy M. Drury contributed to this report. To contact writer Becky Purser, call 256-9559, or find her on Twitter @becpurser.

This story was originally published October 21, 2015 at 8:07 PM with the headline "New mammogram guidelines raise concerns in Middle Georgia ."