Events

Many of us in the leadership of the breast cancer advocacy movement have been receiving
unfair...and even nasty messages. I have been thinking for 2 days how to respond and then
received Susan's message. She says it best for ALL of us.

"I hear your anger. I’m angry too. But not for the same reason. I’m angry because we’ve
oversold the benefits of mammography to the extent that there is no longer room to look
objectively at the evidence. Let’s work together to examine the evidence and to advocate
for the research funding that will end this disease." SL

Wednesday, November 18, 2009
A Message from Dr. Love about the New Mammography Guidelines

I have read and listened to all of the calls and emails that have come into the Foundation since I first
appeared on TV talking about the new United States Preventive Services Task Force guidelines.

It’s very distressing to me that many of you think that I’ve abandoned you and your concerns.
I have spent my entire career working in the breast cancer field. I want to find an end to this insidious
disease. If I thought that these guidelines would harm women, I’d be the first person to speak out.

These guidelines are just that—guidelines. The guidelines aren’t saying that women between 40-50 should
never have a mammogram. Women under 50 who are high risk should have a more intensive screening
program that includes mammography. Women younger or older than 50 who see or feel a change in their
breast should have a mammogram or ultrasound so that the problem can be diagnosed.

What they are saying is that a careful review of the scientific evidence shows that there is no data to
support the idea that the benefit of mammography outweighs the risks for women between the ages of 40-
50. Understandably, this is a shocking statement to hear, as it completely contradicts the “women should
get an annual mammogram starting at age 40” recommendation that we’ve been hearing for the past
decade.

What many people don’t know is that this recommendation to extend screening to women under 50 was
fraught with controversy. The decision was not based on evidence; it was based on political will. Virginia
Ernster wrote an excellent article about this in the American Journal of Public Health in 1997.
Since then, we’ve become even more focused on the need for health care that is evidence-based. This is
not just because of the cost factor. (The evidence may show that a more expensive drug or procedure is
better, and that’s what we will need to then follow.) It’s because studies have shown us that treatments or
tests we thought would be more effective were not. That’s why research is so important.

The problem with mammography in women under 50 is that it doesn’t work very well. Breast tissue is dense
in young women and appears white on a mammogram. Cancer also appears white on a mammogram. This
means that trying to find cancer on a young woman’s mammogram it is like looking for a polar bear in the
snow.

As a result, mammography misses many cancers in young women. And not only does it miss many
cancers– giving a false sense of security–it also finds many things that are NOT cancer but need to be
checked out through biopsies or other tests. In addition, the risk of the radiation is higher in younger
women.

As some of you have noted, I have been trying to develop a new method of finding breast cancer early. For
many years, I was focused on ductal lavage. I am still interested in the intraductal approach, but am
currently doing less work with ductal lavage. I am not in favor of these new guidelines because I think it will
create an opening for ductal lavage. It doesn’t.

Also, to be clear, I have not been influenced by any donations from an insurance companies, nor have I
been bought off by our Federal government, nor do I think that these guidelines are part of a government
conspiracy.

In fact, if you look back at what I have written over the years, it is consistent with what I am saying today:
mammography is not a good tool for finding breast cancer in younger women. Yes, it is the best tool we
have. But even the best tool might not be good enough for what we are using it for.

What I hope these guidelines will do is push doctors to have a conversation with their patients about the
risks and benefits of mammography so that women can make a decision that is right for them. If, knowing
the risks, you want to have a mammogram, that should be your choice. But you should also know that
mammograms are not all that good at detecting breast cancer in women under 50, so that you can be alert
for any changes you see in your breasts.
So, why do these guidelines make sense?

The real issue is not whether mammography can find cancers but whether it can find them at a point that
will make a difference in the outcome.
The magic of 50 is menopause. As a woman’s hormones wane her breast tissue becomes less dense and
the mammograms become easier to read, shifting the risk benefit balance. Before 50, it’s a different story.

If you are high risk, you and your doctor should develop the appropriate screening program for you.
Depending on your age, and your breast density, this might also include MRI. And no matter how old you
are, you should see your doctor if you see or feel any changes in your breast.

I hear your anger. I’m angry too. But not for the same reason. I’m angry because we’ve oversold the
benefits of mammography to the extent that there is no longer room to look objectively at the evidence.
Let’s work together to examine the evidence and to advocate for the research funding that will end this
disease.

New task force guidelines put screening in proper perspective
By Fran Visco

Independent, objective experts in public health examine the scientific evidence and conclude that the data do not warrant a
universal recommendation for mammography for all women in their 40s. Sound familiar? Actually, those were the findings of a
National Institutes of Health consensus report in the 1990s.

Science also tells us that monthly breast self-examinations do not find breast cancer earlier or save lives, but that they do produce
harms. That might seem counterintuitive, but it is reality.

Yet the medical oncology community, government officials and many advocacy groups encouraged the public to put their faith in
screening and early detection — to such a degree that some even equate screening with prevention of breast cancer. All of this has
been done despite the lack of strong scientific evidence.

This is not an issue of what we want to believe or what we have been told. The issue is, "What does the science tell us?" Women
deserve the truth even when it is complicated. They can accept it.

National Breast Cancer Coalition (NBCC) hopes that Monday's release of the U.S. Preventive Services Task Force's revised
recommendations will put screening and its limitations into proper perspective. Remember, screening is for a healthy population —
not those with symptoms or already diagnosed with disease.

For more than 10 years, NBCC has reviewed and analyzed the evidence. The coalition has informed the public that screening has
significant limitations, and that mammography should be a personal choice rather than a public health message.

We should put our resources toward finding new treatments, figuring out which types of breast cancer are deadly and, most
important, discovering preventive measures that could actually save lives, rather than continuing to invest in false hope.

Fran Visco, a breast cancer survivor for more than 20 years, is president of the National Breast Cancer Coalition, an organization that
seeks to end breast cancer through grassroots action and advocacy. Its website is stopbreastcancer.org.

Posted at 12:21 AM/ET, November 18, 2009 in USA TODAY editorial | Permalink