Letters: More on Mammography Guidelines

Constance Lehman, medical director of radiology and director of breast imaging at the Seattle Cancer Care Alliance, explains what new the recommendations for routine mammograms could mean for women who do not know their risk for developing breast cancer.

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NEAL CONAN, host:

It's Tuesday and time to read from your emails and Web comments, most of which were divided on the subject of modern blackface. Is it offensive or just irreverent? Rocco sent us an email from Cambridge, Massachusetts to argue blackface is no different than any other costume. It's just makeup for play acting, he wrote, like a man wearing a dress to portray a woman. Get over it.

Another listener disagreed strongly. How could we get over such an integral part of our country's history? Blackface is tied to the whole range of segregation and racial issues, and forgotten history repeats itself. It's not that this is the most important issue in today's society, it's that this is an issue we can change. That from Amy Palace(ph) on our Web site.

The new guidelines about mammograms last week created quite a backlash. The opinion pieces continue even today. The U.S. Preventative Services Task Force recommends most women wait until they reach 50 to start getting routine mammograms.

Sally in Denver emailed to tell us: I wish this study had been done years ago. I had mammograms all through my 40s. I ended up having three needle biopsies, each of which caused a week of anguished waiting for results. I also had a surgical biopsy which was painful for weeks and permanently disfiguring and all of the biopsies were negative. Added to the physical and emotional burden was a financial one. All of this was not cheap.

Task force shmask-force, wrote Sheila Baumgardner(ph). In 2006, my doctor removed precancerous cells in a biopsy. I was 48. Had I waited on the advice of this task force, I may have developed full-blown breast cancer. I believe this is bad information at a time when insurance companies are looking for reasons to cut corners. We fought long and hard to get coverage for annual mammograms. It's also a slap in the face to all of the breast cancer patients under 40 who have died.

Those new guidelines are intended for women who are at low risk of developing breast cancer. Those with a family history of breast cancer are advised to continue annual tests. But how do the guidelines affect those women who don't know their family history? They're adopted maybe or no records exist. We've asked Constance Lehman back for an answer to that question. She's the medical director of radiology and director of breast imaging at the Seattle Cancer Care Alliance and joins us by phone from her office in Seattle.

Nice to have you back on the program.

Dr. CONSTANCE LEHMAN (Seattle Cancer Care Alliance): Oh, thanks for having me.

CONAN: How often do you encounter women who don't know their family history?

Dr. LEHMAN: It's actually fairly often. And so the woman writing in is not alone. Not only are there women who maybe have been adopted, but there are also women that have no siblings, their parents were only children, they just have very sparse family members to draw any kind of history or conclusions from.

CONAN: And in that case, what do you tell them?

Dr. LEHMAN: We recommend annual mammography 40 years and older. We think that if a woman has either a sparse family history or was adopted, unfortunately, we don't think we should treat her as if she's high-risk because the chances that she's high risk is very, very small. But it's missing information, so we continue to recommend annual mammography age 40 and older.

It is very, very, very rare that a woman will be so nervous or so anxious that she wants to talk to her doctor about the potential of her having a blood test to test for a genetic mutation. But we really recommend against that because it's so unlikely to be positive.

CONAN: And there is also the question, though, of getting the test and then the false positives that one of the writers wrote us about.

Dr. LEHMAN: Right. The woman that wrote in about the false positives of mammograms - unfortunately, there are women that will have bad experiences with mammography, women that will come in to us and say it's painful for me, or it's the worst fear and anxiety I ever have is when I have my mammogram, waiting for the results, or my worst experience in my life was my breast biopsy. Those are real experiences. We want them to be very, very rare experiences. In fact, we'd like to avoid them altogether.

For most of our patients, though, they understand when they're called back after a screening mammogram, it's very unlikely they need a biopsy. And when they have a biopsy, it probably isn't cancer, but it's the methods that we use currently to find those cancers that need to be found and need to be treated.

CONAN: But even if these women are average risk, for example, that doesn't mean they get off scot-free here?

Dr. LEHMAN: Exactly. In fact, one of the points that we think is very important for women to hear, if we look at all women diagnosed with breast cancer in their 40s, 75 to 90 percent are completely average risk. They have no additional risk factors, except the fact they're a woman. So there is no magic method we have now to assess a woman's individual risk and tell her you will or you won't get breast cancer in the future. Again, the vast majority of women diagnosed with breast cancer have no risk factors.

CONAN: Thank you very much. Constance Lehman is medical director of radiology and director of breast imaging at the Seattle Cancer Care Alliance. She was with us today by phone from her office in Seattle.

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