“From what I’ve seen in my office, after this big study the government did on Pap smears and mammograms, everyone, even the patients, are up in arms,” said Dr. Alan Fairchild of Knox Gynecological Specialists. “And they still want to get there mammograms every year after 40 and want to get their Pap smear every year despite what the government has said.”
“It’s kind of sad; it has taken all these years to get women to do their own breast exams and to have the screening done, and we finally feel like we have made it public and easy access to mammograms. Now it all might change with these recommendations,” said Dr. Amy Murnen, Mount Vernon Family Practice.
Fairchild and Murnen agree the final decision on testing should be between the physician and the patient, and all options will be taken into consideration.
“But I still think that everyone should get a mammogram once a year after age 40,” said Fairchild. “Women who get a cancer in their breast in their late 30s and 40s up to mid-50s, they are usually very aggressive cancers and if you don’t find them early, they can die from it.”
“I think that unless the insurance companies are absolutely mandating [a mammogram after the age of 50], I think physicians will continue to perform as before. It may not be every year, it could be every other year, but it will depend on the patient’s risk,” said Murnen.
Fairchild agreed with the task force’s recommendation against breast self-exams.
“[Breast self-exams] are worthless unless the tumor is so big, like the size of a golf ball. They’re not going to know what they’re feeling, but that’s why it’s so important to not only have a mammogram, but to have a breast exam by a board-certified gynecologist each year,” said Fairchild.
Murnen is a firm advocate for breast self-exams, and has told women — and will continue to tell women — of their importance.
“I myself have had cancer at the age of 40. I was not at high risk and I didn’t have a family history, but I ended up with cancer myself. I had a normal mammogram and it didn’t show it. I went to my physician and my physician didn’t feel it. Yet I was able to feel it by doing my own breast exam; that’s why I believe self breast exams are one of the most important things. ... I completely disagree with [the government task force’s] recommendation to not do self breast exams,” she said.
“We’ve always told women that it is very important to have your mammograms done after age 40. But I do individualize it with my patient. If they feel more comfortable having them every year, I will do them every year, but I take into account what the patient wants and family history,” said Murnen.
Mammograms aren’t 100 percent accurate, said Murnen, but they can detect a lump much smaller than a person can feel.
“And if we’re not doing the screening of mammograms as frequently, they will have to wait until the woman or the physician can feel it, and then the potential [lump] may be at a later stage rather than earlier, and that is a greater concern,” said Murnen.
Dr. Lauren McDowell-Jacobs M.D., Community Surgical Specialists, agreed with Murnen on the importance of self breast exams.
“I can tell you that both in my personal practice and nationally, many breast cancers are found because a woman has identified it herself. So to discourage women in taking an active roll in their health care, their own prevention — it’s irresponsible in my mind,” she said.
“I think for those of us who practice medicine, surgery, and take care of breast cancer [patients], those guidelines are ill-conceived. I don’t mean to minimize the research and time that went into these recommendations, but I can tell you every breast society that I’m involved with has come down pretty hard against these recommendations, and feel like the research that has been accumulated over the last 40 years shows very, very clearly that breast cancer deaths are decreased as much as 30 percent by screening mammography and subsequent early diagnose and intervention.”
McDowell-Jacobs said 70 percent of breast cancer patients have no documented risk factors beyond the fact that they are women, and for 95 percent of women who have breast cancer, it doesn’t run in their family.
“I think the guidelines to be put out there really serves to make women much more confused about what’s the right thing to do,” said McDowell-Jacobs. “If you look at women age 40, less than half the women on the national level have ever even had a screening mammogram, so clearly it’s under utilized even though its been the recommendation for years up until last week. Why would we want to put out further information to confuse women and to make them less inclined to take advantage of something that has been clearly documented to decrease death from breast cancer?”
Over 4,000 mammograms are done each year at Knox Community Hospital, and grants such as the Mother, Daughter, Sister, Friend Project supported in part by Susan G. Komen for the cure Columbus Affiliate, help aid women in the education of breast cancer and the cost of mammograms.
“As the American Cancer Society states, ‘The best detection is early detection,’ and that’s the goal — that we identify something early so that we have early detection and early treatment before it becomes large and more involved,” said Becky Dangelo, MSN, RN, CNOR, BHN, breast health navigator at Knox Community Hospital.
Dangelo said she will not be changing the way she educates women on breast cancer awareness, but will continue to speak on the importance of annual mammograms, breast self-awareness exams, and clinical exams by a physician or practitioner.
“We have to be proactive in what we’re doing for the best health of each person,” she said.