For each patient, the decision is likely to hinge on personal calculations about whether the benefit of detecting any cancer, no matter how small or slow-growing, outweighs the burden of knowledge and the potential drawbacks of treatment. Clearly, there are no easy answers.
While some breast cancer advocates deplore the shift — the Washington-based Black Women’s Health Imperative called on women to ignore the guidelines and continue getting annual mammograms and performing breast self-exams — others say it is long overdue.
Among them is Fran Visco, a breast cancer survivor and the executive director of the National Breast Cancer Coalition. The group posted statements on its website commending the task force and Brawley’s statements.
Oncologist Eric Winer, chief scientific adviser to the Susan G. Komen for the Cure Foundation, says that while the every-other-year mammogram recommendation may seem new, it is not. The American College of Physicians advocated it in 2007. “There’s always been some waffling about it,” says Winer, director of the Breast Oncology Center at Dana-Farber Cancer Institute in Boston.
Winer agrees with other experts who have recommended “regular” breast cancer screening for patients over 50 without risk factors, but not necessarily annual mammograms. But, he emphasizes, anyone who discovers a lump or abnormality in her breast should see a doctor, no matter how recently she had a mammogram.
Eric Seifter, an associate professor at Johns Hopkins University who helps evaluate cancer studies for the National Cancer Institute, says he believes the task force and Brawley “got it completely right.” For women with low or average risk, “I’m comfortable with every other year between 50 and 70 and certainly every other year over 70,” he says. “Over 80, I’m not even sure you need a mammogram, period.”
Breast cancer, says internist Newman, whose younger sister was diagnosed with the disease at 35, exerts a unique emotional power over women. They often hugely overestimate their risk. A recent USA Today/Gallup Poll found that 40 percent of women surveyed estimated that a 40-year-old’s chance of developing breast cancer over the next decade was 20 to 50 percent. The real risk is 1.4 percent, according to the National Cancer Institute.
Newman says she is telling patients without risk factors that they can undergo biennial mammograms. “I’m worried about the person who hasn’t gone for five years,” she says, “not those who go every one to two years.”