Women and risks


Mammogram recommendation becoming pink-ribbon issue
By Liz Szabo
USA Today, 2009-11-23

Breast cancer campaigns have helped raise awareness about breast cancer,
as well as money for research.
But all those pink ribbons have given women
an inflated fear of the disease –
unrealistic expectations about the benefits of mammograms,
says Lisa Schwartz, a doctor at
the Veterans Affairs Outcomes Group in White River Junction, Vt.

That mixture of fear and faith has helped fuel
the backlash against new recommendations
from the U.S. Preventive Services Task Force,
says Fran Visco, president of the National Breast Cancer Coalition.
The independent panel suggested last week that
doctors stop routinely performing mammograms on most women under 50
and instead let women make up their own minds about
the risks and benefits of the screening tests.

For two decades, Visco says, cancer groups
have oversold and oversimplified the benefits of early detection
to get women to follow their advice about breast screening.
Many women now see mammograms as completely positive, with no risks,
and are unwilling to give them up.

“When we give public health messages,
we better be damn sure that they are rooted in a high level of evidence,”
Visco says.
“Taking back our words when we finally have the right evidence
is virtually impossible.”

The American Cancer Society’s Robert Smith,
who supports mammograms for younger women,
says public health messages have to be simple.
“To say ‘screening saves lives’ is a shortcut,” he says.
Screening is
“the pathway to a treatment that reduces your risk of death.”

The decision to have a mammogram is actually more complex than many realize, Schwartz says.
In addition to causing “false alarms,”
in which suspicious results later prove to be benign,
mammograms also lead some women to undergo unnecessary treatments
for tumors that aren’t actually life-threatening,
she says.

“People may have unrealistic expectations
about what mammography can and can’t do,”
says the American College of Radiology’s Carol Lee,
who promotes routine mammograms for women in their 40s.
“But it’s the best test we have to offer, as imperfect as it is.”

Schwartz says she grapples with the question of screening herself.
And she understands
why many young women want to continue having regular mammograms.

But she says doctors need to do a better job
helping women understand the big picture:
“People should be able to discuss these things
and make the decision that’s right for you.”

Women are insistent on mammograms, poll shows
By Liz Szabo
USA Today, 2009-11-24

A vast majority of American women plan to ignore
controversial new recommendations about mammograms,
a USA TODAY/Gallup Poll shows.
The poll also shows that
most women sharply overestimate their risk of developing the disease.

The U.S. Preventive Services Task Force,
an independent panel of government-appointed experts,
suggested last week that
most women don’t need routine mammograms until age 50.
The panel had told women to begin breast cancer screening at age 40.

Women across the USA have reacted angrily to the recommendations
and expressed concern that delaying the tests could endanger their lives.
In the new survey of 1,136 women,
76% of women say
they disagree or strongly disagree with the recommendations.

And 84% of women ages 35 to 49 say
they plan to get mammograms before age 50
despite the independent panel’s advice.
That’s in keeping with the guidance of the American Cancer Society,
which recommends annual mammograms beginning at age 40.

Yet while the respondents expressed strong emotions about mammograms,
the poll found that most women have misconceptions about the disease
and the panels’ motives.

Seventy-six percent of women said
they believe that the panel based its conclusions on cost,
even though the task force’s report included only scientific studies.

Women also perceive their breast cancer risk
to be higher than it really is.

Forty percent of women estimate that
a 40-year-old’s chance
of developing breast cancer over the next decade is
20% to 50%.
The real risk is

according to the National Cancer Institute.

[That figure seems inconsistent with the table below.]

“It’s gratifying that most women have gotten the message that
they should get a mammogram and get it annually,”
says Otis Brawley, the cancer society’s chief medical officer.
“Unfortunately, your poll also shows that
we still need to do a lot in terms of health education.”

The task force didn’t rule out mammograms for women younger than 50,
but it suggested that women in their 40s talk to their doctors about
the benefits and risks of screening,
which include false alarms and even unnecessary treatment.
Ten percent to 33% of early breast tumors have no potential to kill,
Brawley says.
Because doctors can’t be certain which tumors will prove deadly,
they tend to treat all of them,
which subjects some women to unneeded therapies.

Most women hear only about the benefits of mammograms,
and few realize that
doctors have been hotly debating their use for more than a decade,
says Steve Woloshin, a physician at
the Veterans Affairs Outcomes Group in White River Junction, Vt.

Doctors need to do a better job of explaining these risks to patients,
and that might help women feel less suspicious
about efforts to target mammogram use,
Woloshin says.

The telephone survey has a margin of error of +/— 4 percentage points,
but the margin of error for questions posed only to the 284 women ages 35 to 49
is +/— 7 percentage points.

10-year risk of death from breast cancer
Without screening 0.33% 0.89%
With screening 0.28% 0.69%
Absolute reduction in risk 0.05% 0.20%

Source: Steve Woloshin, Veterans Affairs Outcomes Group

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