For a woman who just had a normal mammogram, her physician's
parting words of "see you next year" have become standard.
But over the last few months, doctors and patients have been
wrapped up in a firestorm of controversy following federal
guidelines that disputed their belief in the frequency of
In November, the U.S. Preventive Services Task Force issued new
guidelines that recommended women at average risk of breast cancer
don't have to go for routine screening until age 50, instead of the
current standard of age 40. In addition, the group recommended that
women ages 50 to 74 can get screened every two years instead of
annually, and that self-breast exams were not helpful in detecting
Following worries that insurance companies would use the
guidelines to scale back their coverage of mammograms, the U.S.
Senate approved an amendment just before Christmas that promises
mammogram coverage starting at age 40. It's not known whether the
amendment will stay in the final bill.
But the uncertainty has already been created, said Dr. Ann
Archer, medical director of the Integris Comprehensive Breast Center
of Oklahoma, and she and many of her colleagues have been vocal in
"It's confusing a generation of women in their 40s and 50s,"
Archer said. "For these guidelines to come out now, when our
strategy in medicine is supposed to be preventive, is ridiculous."
Doctors can counsel their patients individually about their
opposition to the guidelines, but it's the women they don't know
that causes more concern. Dr. Elizabeth Jett, director of imaging at
the University of Oklahoma Breast Institute, said she's afraid the
guidelines will affect women who are reluctant to have a mammogram
for whatever reason.
"I'm worried that it will be an excuse for them not to come in,"
Jett said. "It's a way for them to rationalize, 'These people say I
don't really need a mammogram, so I won't get one.'
"But 25 percent of the cancers we diagnosed in 2009 were in women
under age 50," Jett said. "That's a significant number of women who
developed breast cancer before age 50."
Both physicians disagree not only with the task force's
recommendations, but with the rationale behind them and the process
that put them together. The task force was comprised of federally
appointed doctors and nurses who are not directly involved in the
treatment of breast cancer, Archer said, and the process was carried
out without peer review and with studies that are "highly suspect. …