From the July 2018 issue of HealthCare Business News magazine
Additionally, larger tumor size is one factor that predicts that cancer has spread to the lymph nodes, which often warrants more extensive node removal. This increases the risk of the difficult, chronic arm swelling known as lymphedema. In addition, lymph node spread is a critical factor in the need for chemotherapy because once cancer spreads to the lymph system. It is more likely to have disseminated in the body. Chemotherapy is associated with a variety of undesirable side effects: neuropathy, nausea, the dreaded hair loss, and even secondary malignancies including leukemia.
Clearly, mammography not only saves lives but also spares many patients less aggressive, extensive treatments, with potential long term difficulties.
Our recent study was the first, to our knowledge, to show that women who had had more recent mammograms leading up to their diagnosis were less likely to require aggressive treatment regimens. The findings provide important discussion points for women who are deciding whether to take advantage of recommended breast cancer screening.
In recent years, the United States Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) have changed their recommendations regarding age to start mammograms and frequency thereafter. These organizations are inconsistent regarding guidelines, with USPSTF recommending only selective mammographic screening between the ages of 40-49, and ACS recommending starting at age 45. Furthermore, these organizations changed their recommendations to decrease screening mammogram frequency from yearly to every two years for certain age groups. These new guidelines represent changes from the previous, consistent and more straightforward recommendations for yearly mammograms starting at age 40 for the general population.
The new guidelines have a net effect of reducing the overall number of women recommended for mammography. The impetus is not entirely clear: Cost cutting? Pressure from insurance companies? True concern for patients regarding false positive findings generating unnecessary additional tests and anxiety? Whatever the reason(s), the waters have become muddied for both patients and their doctors regarding when and how frequently to screen.
Women who chose not to undergo mammograms not only have a higher chance of dying from breast cancer, but according to our data, a higher likelihood of requiring more aggressive therapy. This information should be part of the conversation when weighing the risks and benefits of mammography. If, in fact, cost cutting by minimizing mammograms and biopsies was the motivation behind these guideline changes, this may result in simply kicking the cost can down the road. More aggressive treatment will be required to treat later stage cancers. Chemotherapy and aggressive surgery are expensive.
