Doctor Backs New Breast Cancer Guidelines
New guidelines from the U.S. Preventive Services Task Force say women would get almost as much benefit out of having mammograms every two years after they turn 50 as having a mammogram once a year starting at age 40. Dr. Jeffrey Tice, general internist and assistant professor of medicine at the University of California, San Francisco, says the benefits of early screening for women between 40 and 49 are small. He says early testing for these women often results in more false positives , more procedures and more anxiety.
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MELISSA BLOCK, host:
For more on these new screening guidelines, we called Dr. Jeffrey Tice. Hes an internist and a clinical researcher in breast cancer risk assessment and prevention at the University of California, San Francisco. Dr. Tice agrees with the task forces findings that the harm of routine mammograms for women between 40 and 49 simply outweighs the benefits.
Dr. JEFFREY TICE (Internist, Clinical Researcher, University of California, San Francisco): The benefits are very small. Theres often a benefit to starting treatments early, screening early, but you end up treating many, many people who dont need treatment. And its hard to balance those small, subtle harms against the few people who benefit.
BLOCK: Although, if youre those few people who have benefitted, you hear news like this and you say, theyve got to be kidding.
Dr. TICE: Youre absolutely right. But there was recently a study showing that for every woman whose life is saved, probably three additional women are treated who never needed any treatment at all. And they get all of the harms of biopsy, surgery, radiation and chemotherapy and none of the benefits.
BLOCK: You know, Dr. Tice, Ive heard this before that when people say, you know, theres unnecessary anxiety and false positives and fear and worry, that thats a very patronizing approach to take toward womens health, that women may very well be willing to assume those harms if it means that they may be diagnosed earlier.
Dr. TICE: I think thats absolutely right. Thats why I think its important to have a thoughtful discussion with women and if its the appropriate thing for your individual patient and she should get mammography starting at age 40. If a woman does not want to go through the discomfort of mammography and take the risk of false positives and potential anxiety associated with those false positives, then we should also support that decision as well and not make her few guilty for not starting screening at age 40.
BLOCK: You know, there was another recommendation here today that teaching women breast self-examination does not reduce breast cancer mortality, that the harms outweigh the benefits and that really surprised me. What do you tell women about whether they should examine their own breasts for lumps or for changes?
Dr. TICE: So, what I tell women is if they feel a lump, I want them to bring it to my attention immediately. Certainly true that a large proportion of all breast cancers are brought to physicians attention initially because women feel a lump. On the other hand, every high quality study thats looked at, whether self breast exam decreases mortality has found no decrease in mortality at all from self breast exam and its resulted in a doubling in the risk for breast biopsies.
BLOCK: Im sure I quite understand, Dr. Tice, because if women are finding lumps in their breast that in some cases do turn out to be cancerous, I mean, think of Elizabeth Edwards. Theres a very high-profile case right there. What is the harm that is outweighing potential benefits?
Dr. TICE: The harm is twice as many women finding a lump, being anxious and having a surgical procedure to remove the lump or at least to put a needle into the lump. And if this doesnt result in any improvement in mortality, were not doing these women any favors.
BLOCK: Dr. Tice, do you think women are confused about this right now? I have to say, I read this study and it seemed to fly in the face of everything Ive ever assumed I knew about breast cancer and breast health.
Dr. TICE: Well, its very confusing. Breast cancer is the most common cancer in women. Breast cancer also kills a number of young women. Its the leading cause of death for women in the 35 to 55 year age range. It causes about 1 in 10 of deaths in that age range and so, we want to do everything we can to prevent that. And screening sounds good. Unfortunately, our current screening is not as effective as we would like it to be.
BLOCK: Dr. Tice, thanks for talking with us.
Dr. TICE: My pleasure.
BLOCK: Thats Dr. Jeffrey Tice. Hes a clinical researcher in breast cancer risk assessment and prevention at the University of California, San Francisco.
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