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Advocating for breast cancer screenings

Advocating for breast cancer screenings
(KEN KOONS/STAFF PHOTO / Carroll County Times)

If Dawn Weeks had not been screened for breast cancer when she was 46, she doesn't believe she would be alive today.

The Westminster resident, now 48, was diagnosed about two years ago and after undergoing a bout of chemotherapy and radiation treatment at Carroll Hospital, has been cancer free. Weeks was among nearly 30 people who met with U.S. congressional leaders this summer to urge them to delay the passage of the U.S. Preventive Services Task Force's draft breast cancer screening recommendations, which would recommend mammogram screening to begin in women at 50 and be conducted every other year thereafter.

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The recommendation has drawn criticism from medical professionals and other advocates who say insurance companies will no longer be required to pay for mammogram screenings for women in the 40-49 age group if the recommendations are finalized.

While the recommendation does not suggest against mammography screenings in the age group of 40-49, it emphasizes that screening, "must be an individual one, made only after a relative (parent, sibling or child) with breast cancer may potentially benefit more than average-risk women in this age group from beginning screening mammography before age 50 years," according to the U.S. Preventive Services Task Force recommendations.

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"Had I waited until I was 50, I wouldn't be sitting here," Weeks said. "Just because it didn't run in my family should not determine when we start pre-screening with these diseases."

In response to the U.S. Preventive Services Task Force recommendations, U.S. Sens. Barbara Mikulski, D-Md. and Kelly Ayotte, R-N.H., championed legislation, along with Congresswomen Renee Ellmers, R-N.C., and Debbie Wasserman Schultz, D-Fla., called the Protect Access to Lifesaving Screenings Act, to protect mammogram screenings in women ages 40 to 74 by placing a moratorium on the guidelines to prevent them from being finalized to "allow time to examine the concerns being raised about the USPSTF process," according to a press release from Mikulski.

The bill was assigned to a congressional health subcommittee on July 31, where it will be considered before it can be sent to the House of Representatives and the Senate.

Weeks was asked to speak against the recommendations, along with her doctor, Dona Hobart, medical director of the Center for Breast Health at Carroll Hospital. Hobart who called the recommendations a "huge step backward."

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"These are women that take care of their families; they generally put themselves last and so the insurance companies are ready to jump on board, we know that," Hobart said, adding that once the guidelines go into effect, she expects insurance companies will no longer pay for the screenings for women younger than 50.

According to an April 21 press release from U.S. Preventive Services Task Force, research indicates that, "some women in their 40s will benefit from mammography, most will not, while others will be harmed."

"Mammography is an important tool in reducing the number of breast cancer deaths. Based on the evidence, the Task Force found that screening is most beneficial for women ages 50 to 74," U.S. Preventive Services Task Force immediate past chairman Dr. Michael LeFevre said in a prepared statement. "The evidence shows that screening women ages 40 to 49 is beneficial, as well, but fewer women will avoid a breast cancer death by screening at this age."

But Hobart said she treats many patients who develop breast cancer between the ages of 40 and 49, and some who are younger.

"It's insane how many people are diagnosed with breast cancer at a young age; I can probably name you five patients who are in active treatment here who are under the age of 40," Hobart said.

In its recommendations, the task force says the most serious harm could be unneeded diagnosis and treatment for a type of breast cancer that would not have posed a threat. A false-positive test result that often leads to additional tests and procedures could provoke anxiety within women, which is harmful, according to the release.

"I would much rather have a false-positive and have 20 mammograms than have that one conversation that I had breast cancer," Weeks said. "Mammograms are not invasive; they're a quick test."

Hobart said overscreening doesn't equate to over-treatment.

"We in this profession really are charged with trying to continue to figure out what the appropriate level of treatment is, and breast cancer is very diverse — it's not one disease… and so I do think — are we over-treating some, absolutely, but we're working on that," Hobart said.

Hobart argued that anxiety in patients who get high-stage breast cancer is much more likely than those who experience anxiety due to mammogram screening.

She also pointed out that the American Cancer Society recommends annual mammogram screenings for women 40 and older who are in good health.

According to the American Cancer Society website, mammograms, "should be continued regardless of a woman's age, as long as she does not have serious, chronic health problems such as congestive heart failure, end-stage renal disease, chronic obstructive pulmonary disease and moderate to severe dementia."

The proposed changes could prevent access to mammography for approximately 22 million women between the ages of 40 and 49, according to the release from Mikulski.

"This will potentially impact our entire country and culture," Weeks said.

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