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New breast cancer screening guidelines
What do the new recommendations mean for you?
- Dr. Richard Birtwhistle, co-chair of the Canadian Task Force on Preventive Health Care and a professor in the departments of family medicine and community health and epidemiology at Queen's University, joined us to discuss the new breast cancer screening guidelines.
The new guidelines say Canadian women under age 50 who are at an average risk of developing breast cancer should not have routine mammograms, and also advise against self-exams at any age.
Read our coverage of the guidelines HERE.
Read a transcript of the discussion below.
- I look forward to the discussion tomorrow.
- Dr. Birtwhistle, thanks for joining us today. We'll kick off the discussion in just a few minutes.
- I am here and available for questions.
- The coverage says that women under 50 with 'average' risk shouldn't have routine mammograms. How do you define average?
- Those women without a personal or family history of breast cancer , with a genetic cause of breast cancer or with a history of chest wall irradiation.
- Good morning. My mother was diagnosed with breast cancer at the age of 42 after finding a lump on her own, and passed away from the same at the age of 44, this was 15 years ago. I have been going for yearly mammograms for the last 6 years and have just turned fourty this year. Can someone please clear up the guidelines for me. Yearly mammograms still? Self breast exams? I am terrified of this disease the older I get!
- You do not fall into the average risk category and these guidelines do not apply. You should continue to follow your doctor's advice.
- For women over 40 who take hormones (progesterone, estrogen), would this be considered in the average risk category?
- Women taking hormones would continue be considered average risk if they don't have the risk factors mentioned below.
- I have read that the recommendations are based on old or outdated data and you did not take into account more recent material. How to you response to this?
- That is misinformation. Our last literature review was done in Oct 2011 before the release of the guideline. We have assessed the evidence up to that time.
- Is anything being done to replace screenings? Like more education on changing your lifestyle to reduce your risk?
- Interesting question. There is some epidemiological evidence about diet and breast cancer but there is nothing structured being done to teach women about this that I know of.
- I should add that screening is still useful. There is benefit for women 50-74 to have regular mammograms every 2-3 years
- Good morning. My doctor has asked me to have a mammogram. I am 51 with no family history, nonsmoker on good health. I told her I didn't think it was necessary. What should I say if she presses this issue. I have had two mammograms in the past four years with no problems identified. I feel reasonably confident I don't need another right now.
- The evidence suggest that there is reduced mortality in women who have a screening mammogram in your age group. There are risks of false positives as well so it is an individual decision that should be discussed with your doctor. We have suggested that the frequency can be every 2-3 years based on some European studies.
- i don't understand the advice against self-exam, it seems counter-productive. what's the logic?
- We are not suggesting that women stop touching their breasts but there have been several trials of breast self examination and they have shown that there is no benefit in decreasing deaths but it results in more lumps being felt which lead to more tests and finding of benign disease. This creates uneccesary anxiety.
- We're told that death rates from cancer are falling. Isn't that partly because of the contributions made by screening?
- It is hard to know how much breast cancer screening has contributed to the fall in death rates compared to improved treatment. There is controversy about this but some believe it is mostly related to treatment.
- My mother was diagnosed post-menopausally with an estrogen receptor negative tumour. Does that mean my risk is greater when I'm pre-menopausal? Can I still wait until after 50?
- Even though your mother had an estrogen negative tumour, you would not be considered average risk and therefore these guidelines do not apply and you should discuss with your doctor.
- The medical community has caused terrible confusion about how to deal with prevention and detection of breast cancer. Anyone who has watched a friend or loved one die of breast cancer knows the agony. I do not think the medical community is unanimous in advocating AGAINST breast self-examination. Perhaps women have to be taught early what kinds of breasts they have (dense or not, etc) and how to do proper BSE. I suspect it all comes down to trying to keep down costs.
- Cost was not a factor in our recommendations. The trials of BSE were randomized and the BSE group was given thorough instruction about how to examine their breasts. It did not result in improved outcomes
- I've always heard that it's best to catch cancer early so it can be treated. Isn't that true anymore? Won't this result in fewer cases caught early?
- That is what we have been lead to believe. Unfortunately there are cancers that even if found early will not be curable and there are cancers that if found early would not have grown if they were left alone or some may disappear on their own. So the answer is not straight forward.
- Hi Dr. Birtwhistle, I am the reporter who wrote about the guidelines this week. After the new guidelines came out recommending against routine mammograms for women in their 40s who have an average risk, several critics have come forward saying this will literally result in the deaths of women in Canada. How do you respond to this? And why do you think we are seeing a backlash against this recommendation?
- Breast cancer is a very emotional issue and we are all trying figure out how to deal with it. I think the critics of the guideline have done a good job at scaring women. It is unclear to me how they arrived at their numbers but our thorough review of the literature shows that while there is a mortality benefit from screening in those 40-49, it is small (1 life saved by screening 2000 women ever 2-3 yrs over 11 years. There are also harms of false postives and overtreatment. It is important for women to know both the benefit and the risk and be able to make a decision for themselves in consultation with their doctor
- Hi Dr. Birtwhistle, I'm 36 years old. My aunt died of breast cancer, which puts me outside of the 'average' group, I believe. When should I start doing mammograms?
- I cannot comment on individuals. I think you should talk to your doctor about it.
- As a family doctor, what is your recommendation going to be to your female patients?
- I think our guidelines are balanced and reflect a thorough review of the evidence to date. I will follow them but the discussion with individual women is important. We are using population level data and trying to apply it to single women. If a women in my practice who is 48 wants to have a mammogram after discussion of the risks and benefits, I would go with her wishes.
- I for one would like to thank you for this research. To me, it's pretty clear but it seems like many women are confused. Does the task force have any plans to promote education to help eliminate confusion?
- Thank you. Our message is nuanced and different from previous guidelines so there is confusion. We have developed some tools for women to use which will be on our website www.canadiantaskforce.ca. We will continue to try and get our message out in social media and elsewhere in the future.
- i'm still unsure about the benefit of this recommendation -- who is this helping? is it saving tax payers money? why not get tested every year?
- The recommendations have not been made to save money. We have looked thoroughly at the evidence related to benefits and harms of screening for breast cancer. There is no evidence in women 50-74 that yearly screening will provide any better results and may result in more tests and false positive findings.
- What's your opinion of having a yearly physical exam by a doctor?
- I could talk about that for a long time but I won't. I want to focus on the new breast cancer guidelines
- How did the task force go about setting the new recommendations? What was involved in the decisions?
- It was a 12 month process. We developed a small working group of task force members to develop an analytical framework and key questions which were reviewed by experts (both family physicians, cancer specialists and methodologist). The key questions were assessed by an exhaustive literature search by one of Canada's leading eviidence review centres. The evidence was assessed by the task force and recommendations were discussed and approved by all task force members.
- "there are cancers that if found early would not have grown if they were left alone or some may disappear on their own" This is very interesting. In my own experience, I think the medical system errors on the side of over-testing. It's difficult to quantify the impact of stress and anxiety on health in these scenarios and find the "right" amount of testing for each individual situation. Thank-you for your comments today. Most helpful. Bottom line for me, be informed of the guidelines and keep discussing with your doctor.
- I should add that the recommendations were also reviewed by cancer specialists and others. It went for further review by the journal before publication.
- Thanks. I agree
- That's all the time we have for today. Thank you, Dr. Birtwhistle, for joining us. Any last thoughts?
- I have enjoyed participating in this forum. I would be pleased to hear from anyone about how we can decrease the confusion for women about this important issue.
- Thanks again - and thanks to readers who participated.
