Thanks, Mary Ann! I saw that story on NBC News this evening: What You Need to Know About New Mammogram Guidelines - NBC News http://ow.ly/TF3PO

Melodie Benford There have been issues with false positives and over-diagnosis, which is why I think it's great that they have loosened their recommendations. Overall, screening mammograms do not find about 1 in 5 breast cancers and about half the women getting annual mammograms over a 10-year period will have a false-positive finding. The data supports the change.

http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/mammogramsandotherbreastimagingprocedures/mammograms-and-other-breast-imaging-procedures-mammogram-limitations

Karen Boyd, ASQ CQA Thanks Melodie.
False positives could be quite burdensome for women with dense breast tissue.
Sounds like these new recommendations are valid.

I agree and like the idea of less radiation

Chang-Ming Yang I do not agree.

Russ Alberts The recommendations are long overdo. As far as screening methods go mammograms are a poor one compared to others. Younger women are more prone to false positives and their breast cancers tend to be the fast growing kind that mammograms are less successful at catching in time. False positives can be serious. A few years ago the NY Times ran an article about women who had had breasts or parts of breasts remove only to be told, "We are sorry. We thought that was cancer but it was not." That happens to about 5,000 women a year in this country and some of them have already begun chemo or radiation - both of which are associated with causing cancer.

Russ Juno Well as a surgeon and I do not agree. There is data on the other side as well. Russ your comment about women without cancer getting chemo or radiation is absurd. You need a tissue diagnosis before starting either one of the. And as someone who has done biopsies and actually talk to my patients afterwards. I would not apologize for a negative biopsy. there is no need to. And in the FORTUNATE case I would tell the woman "Great News..its Benign!"

Karen Boyd, ASQ CQA Russ Juno - What is your position on women who have dense breast tissue, whereby mammograms may not detect cancer?

Russ Juno Don't quote me, but as you says woman with dense breasts are harder to detect and according to new guidelines should start earlier at 40. they also should do monthly self breast exams and they may consider ultrasound with the mammogram or MRI. I would still recommend monthly exams. As a woman you should know your body! If there is a change bring it to your doctor. I also highly recommend you stick with your same doctor for yearly exams. And also try to stay with the same hospital or radiology group to do these xray annually. It is easier for them to compare. I live and work in a small town. So for women getting their mammograms they have the same 2 doctors reading them for the past 6 years. To me that makes a difference. My wife is 42 and has already had 2 mammograms and will continue to get them annually. Its your life. I already have trouble trying to get women over 45 or even 50 to get them routinely. And then the comment about 10 years left to live. What is that?

Karen Boyd, ASQ CQA Thanks Russ.

Julie Omohundro Russ J, the fact that "you" may "need" a tissue biopsy first does not mean that every woman will get one, trust me on that. With over a quarter million women being "diagnosed" with breast cancer annually in the US, an estimated 5,000 going straight to surgery without tissue biopsy strikes me as most likely on the low side.

Do you know why the women over 45 or even 50 that you already have trouble trying to get to have a mammogram routinely don't get them?

Russ Juno Karen, I hope so too. But there is still debate on this and this leads to "confusion" by patients, docs and other providers and leads to an excuse not to get it done.

Melodie Benford Well, in my experience, when I make an appointment with the doctor, they recommend arriving 15 minutes early and they usually don't see me until 20-30 minutes after my appointment time. Then the nurse checks my vitals, and I wait in the room by myself for another 10-15 minutes, so it's not laziness. If in all, it only took 10 minutes along with the procedures being painless and the doctors were warm (not rushed and dismissive), you would definitely see me more often. Unfortunately, more times than not, that's not the case. I've had very poor experiences with doctors (in general, not specifically), which is why I am appreciative of measures that say I need to see them less.

Karen Boyd, ASQ CQA Wow....guess I've been lucky!

Julie Omohundro "Russ J, I meant surgery as treatment, not for diagnosis.."

Julie Omohundro Melodie, I think your experience is fairly typical, with a lot more worse out there than better. If you have to visit a clinic at a hospital or medical center, or one of those clinics that like to cluster conveniently (for them) around these facilities, you can add time navigating a maze of streets, often with poor signage, cruising overflowing parking lots, waiting on elevators, trekking down long corridors. In and out, add at least 30 minutes to your timeline.

Russ Juno Anyone is welcome to come make the trip to Texas to come to my office. My wife is an OB-Gyn and decorated it. On a slight turn from this about the office waits. I am going to take this opportunity (not to justify) for educate you all on something that is driving us surgeons mad. Behind the scenes after the visit we use electronic records. this has been a mandate by your federal government. Sound good initially, heck we use electronics is every other part of our lives. However the technology in medical records is ancient. With the mandates prices skyrocketed and vendors popped up in order to get a piece of the mandated money. So they are horrible and inefficient to use. Then on top of that the government is tracking (useless data from a medical standpoint) about our patients and we must keep and submit this or fear financial penalties. so I tell you this to let you know what is going on. And to do this data mining for them takes me about 10-15 more per patient encounter (and I think I am computer savvy.) So multiply that for each patient. This takes time away form the patient that I could spend with them. We still try to get you into the office but I have less time and do run over often. Especially as with that cancer patient last week when I need more than the typical 15 minutes to go over things. Anyway thanks for listening to that.

Julie Omohundro "Too busy" can mean a lot of different things.

I think a lot of women don't want a mammogram because they don't want to have cancer and/or be treated for it. (Some people are more afraid of the one than the other.) Some want it both ways...they don't want to have or be treated for cancer, but they don't want to die of it, either. For these women, "too busy" is a form of denial. They don't want to have to deal with the issue at all.

Others educate themselves, realistically weigh all the options and the probabilities, and then make an informed decision to spend their time having mammograms and other recommended routine screening and diagnostic tests, or not, based on their personal philosophies.

Regardless of the reasons, as Russ J has noted, it is their life, which means that it is their choice to make, for whatever reasons they choose to make it. Sometimes "too busy" is just a diplomatic alternative to MYOB.

Karen Boyd, ASQ CQA I think your frustrations regarding electronic records is valid (average 7 minutes per patient?) and a double-edged sword of effective compliance vs. efficient service. This could be a topic or two alone!

Russ Juno Julie, the previous comment as about chemo and radiation without a biopsy. As for surgery was do you classify as "surgery?" Sometimes a biopsy required surgery. As for why they don't....I've heard all kinds of excuses. And BTW when I made that comment I am referring to women with insurance and it is basically already paid for.

Marie Suetsugu I just took 'the comment about 10 years left to live' to point at the fact that, like my grandparents and my parents' friends' parents, one does get suspected of having a cancer in her/his 80s and, even when her/his children say repeatedly that s/he wouldn't even get tested as s/he wouldn't be operated on at that age anyway, the doctor keeps insisting that s/he should get tested...and months later says, 'Oh, the cancer has disappeared'... This is unfortunately a true story. Though we are in Japan and this was about 10-15 years ago and it was not a breast cancer.
In Japan the government (still) recommends that women start having a mammogram at the age of 40. So, some of my friends who haven't got mothers or aunts with a breast cancer have also started to have a mammogram this year. But personally I am not planning to (I have so far no relative with a cancer)......

In my opinion after years of recommending what women should do..this is an insurance based scam...now insurance will probably decide not to cover routine..so I hope our rates go down..stay tuned..

Julie Omohundro Russ J, I meant surgery as treatment, not for diagnosis.

Odd that they would all have different reasons. Usually when a lot of people all do (or, in this case, decline to do) the same thing, it is for the same reason. What kinds of different reasons did they give?

Julie Omohundro Although I guess you already answered my question. You don't know why they don't get them.

Russ Juno Julie, I don't want to say laziness, but basically I think it is "no time, too busy" but I do not know. And these women have insurance so know financial excuse. I just saw a 68 year old who had not had a mammogram in about 5 years. Noticed a lump and ignored it, now has cancer. I am not a psychologist, though I work in a rural town and deal with a lot, but I think fear and ignorance(lack of knowledge) is a key too.
Marie, as to the later ages. I live out in the country in Texas. I have practiced in urban areas as well. My community definitely lives a longer out here and they are usually very active til the end. In my practice, and this is just me, I can not comment or claim to understand what other docs do, I also do colonoscopies. No real end age given for that either. But If someone is around 80 and in "good health" I would do the screen. So the same thing for mammograms. I also am not a woman and have never had one but a mammogram is less invasive than a c-scope. So same thing, if you are in your 80's and still "healthy get it done! I still see many breast cancer patients in their late 70 and 80s who have skipped a few years and now have cancer. Really the only "people" this benefits is the insurance company. And it is a dream if you think they will now reduce your premiums!

Russ Juno Julie, also what do you mean by there are women who go straight to surgery?

Karen Boyd, ASQ CQA I hope it's not laziness or being too busy. Ideally, it only takes about 10 minutes. (I've sat in a drive-thru line longer!)

Russ Alberts Russ Juno, you seem to misunderstood my earlier comment. I was not talking about negative biopsies but too frequent false positives. In 2006, Susan G. Komen for the Cure reported that there are about 90,000 women a year who are diagnosed with breast cancer but actually do not have it. About 5,000 to 10,000 of these go on have unnecessary treatment. The full article by Stephanie Saul in the NY Times from 2010 can be found at http://www.nytimes.com/2010/07/20/health/20cancer.html Don't miss the video.

Marie Suetsugu Russ J,
Excuse me for having to say this, having to make myself clear, but you are missing the point: you can only suggest whatever you may want to suggest; you can't just do it, the decision is ours. My mother's had at least two friends who lost their elderly parents right after surgery which they found difficult to resist, despite my mum's advice against surgery at that sort of age. Unlike my family, people in general (especially in Japan, perhaps) are not strong enough to confront medical doctors. And the surgery is always a success, only the complications kill them... So my point is: you can inform us, but we may very well not consent to it.

Russ Juno Marie, I am not missing any point. I turn down people for surgery more than I do them. I take everything into consideration. But that is also not the point of this discussion. It was asking about the new guidelines. Do I as a surgeon and husband of a woman like them...No. I was trained the way I was and I read and interpret data with my own mind and offer that to my family, friends and patients. If you do not want to follow them fine. But I caution men and women, who "ignore" screening recommendations. the way I see this country's health system moving, it would not surprise me that in the near future if you do become diagnosed with a cancer, the insurance/government will look back to see if you had screenings. And if you did not they might not cover your treatment.

Russ A. I saw the article and video. Very unfortunate. But form what I saw that was an error and technically has nothing to do with screenings. Treatment of DCIS is evolving. And also even back in 2007 if she was my patient I would not have done a full quadrantectomy and deformed the breast like that. I would have gotten the smallest margin, but that is a whole other discussion.

There is a reason epidemiologists and clinicians disagree. Clinicians get to see their patients, but epidemiologists are actually looking at the data associated with the treated and untreated population. The risk associated with over diagnosis and over treatment is real and not simply remediated by a biopsy. The change in screening standards was first suggested by USPSTF and ACS caved to a compromise position as additional population standards have come in. The changing mammography recommendations prompted similar responses from urological oncologists when USPSTF changed their recommendation on utilizing PSA levels for general population prostate cancer screening. However, if diagnosis and treatment goes up with screening and the associated mortality does not decline (relative to the unscreened population), one has to assume diagnosis and treatment may be creating their own clinical harms.

Health care for the past 20 years has embraced the paradigm general population screening saves both lives and health care dollars, but the objective evidence supporting this position is surprisingly sparse (particularly on a population basis). Medical procedures, device or pharmacological based, come with their own risks independent of disease mortality. One need only look at hospital mortality figures (due infections developed during hospital stays and medication errors) to recognize this general fact. There is a statistical case some researchers have made medical care is most effectively and safely utilized when the diagnosed condition is clearly life-threatening.

Marie Suetsugu Dear Russ J,
I was/am only writing in response to your sentence 'But If someone is around 80 and in "good health" I would do the screen.'
Plus (and this is precisely what I've been trying to get at): if you are missing the point or not is not up to you to decide. I'm not talking about you personally necessarily, but I've observed that sort of 'arrogance' among my medical doctor friends too, so......

Julie Omohundro Karen, there is also the mindset that, if it really only takes 10/30/60 minutes to get a screening mammogram, it wasn't worth doing in the first place. That's because the only reason it stops there is that the result is normal. In that case, it had no positive impact on your health at all. It has value only if you have cancer, and the process from screening mammogram to clear will take a lot more time out of your life than 10/30/60 minutes.

I think many women who say they are "too busy" are not thinking about the screening mammogram alone, but its purpose and where you would go from there, if it serves its purpose, which is not to reassure you that you are unlikely to have breast cancer, but to identify those women who are likely to, and move them farther down the line, with every step typically more time-consuming and unpleasant than the last.

Even if you don't have cancer, from screening to diagnosis can be a long trek. To back up a bit, I neglected to factor into the screening mammogram the travel time to and from, which is rarely less than another 30 minutes and can easily be an hour. That is to visit a facility that offers screening mammograms, which are relatively abundant. Diagnostic imaging facilities are few and far between, so that many women would have to drive an hour, and some several hours, for follow up to an "Inconclusive" or "suspicious" result.

From there you go on to biopsy...we hope, where you may learn that it was all a "waste" of time, and you don't have cancer after all. Or that you do, and then the amount of time you are about to give up out of your life can be months or even years, especially psychologically.

All of this with no guarantee that your likelihood of survival was improved by "catching it early" due to the screening, nor even that you will survive, after all that. If you consider further that your chance of not ever getting breast cancer in your lifetime, no matter what you do or don't do, is 88%, your odds of surviving if your cancer is detected through regular self-exams are not substantially less than (and arguably the same as) if it is detected by way of a mammogram, and that your odds of surviving even if it is not detected until clearly symptomatic are still decent, it doesn't surprise me that many women are "too busy" to get a screening mammogram.

Julie Omohundro Russ, if the insurance/government decides not to provide coverage without screening, then I'm sure more women will find time to get screened. However, I could also see this going the other way.

I don't pretend to understand what does and does not benefit the insurance industry financially, nor why, but if more and more data show little to no benefit of screening mammograms, it seems to me that, at some point, the insurance industry will ask itself whether they are worth paying for. Indeed, the new guidelines could be a step in that direction.

One thing seems certain. We are at the beginning of the age of the epidemiologist, who thrives on "big data," Soon the benefits and risks associated with, not only screening mammograms, but other types of screening and diagnostic tests, and also treatments, will become increasingly (and perhaps painfully) clear.