Mammogram recommendations stir debate in St. Louis medical community

"What this new set of guidelines has done is to come down harder on doctors."

Fred Bodimer
April 16, 2019 - 2:34 am
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ST. LOUIS (KMOX) — The American College of Physicians is out with a new set of guidelines meant to provide clarity to existing and sometimes conflicting mammography screening guidelines.  But it appears to have only added to the confusion. 

"The American Cancer Society currently recommends average risk women age 45-54 get a mammogram every year, then starting at age 55 every other year," said Dr. Tara Narula, CBS News Medical Contributor.   " But the American College of Physicians now says for some women, it should be less frequent.  It recommends the majority of women get a mammogram every other year beginning at age 50."

"And younger women should speak to their doctors about the benefits," said Narula. "But there are exceptions -- women who have had a prior abnormal screening, a previous diagnosis of breast cancer or a genetic mutation known to increase risk."

"The ACP guidance statement says evidence shows annual mammograms can lead to more harm, such as anxiety over false positives and unnecessary testing," said Narula.  "It also showed that annual mammograms versus biennial show no difference in the breast cancer death rate. And the ACP also said doctors should not use clinical breast exams to screen for breast cancer."

Nearly 270-thousand American women are expected to be diagnosed with breast cancer this year.  Many of those cancers are picked up during screening mammograms. 
 
The director of breast imaging for SLU Care and SSM Health -- Dr. Debbie Bennett -- is not too pleased with the American College of Physicians new guidelines. 

"What this new set of guidelines has done is to come down harder on doctors to say in most women you should not encourage your patients in their forties to be screened nor should you encourage patients to be screened annually," said Bennett.  "And I think based on the data that seemingly everyone agrees on there is indeed a strong benefit in terms of lives saved and particularly life years gained for women in their forties from screening every year."  
 
Dr. Bennett recently joined with two other local radiologists in writing a letter expressing their concerns about the guidelines.  The letter was published in the Annals of Internal Medicine. 

The radiologists are worried the new guidelines marginalize minorities.  

"I think based on the data, these guidelines have the potential to adversely affect all of our African American patients much more strongly than our white patients," said Bennett.  "And the reason for that is black women unfortunately are more likely to die from breast cancer and more likely to be diagnosed with breast cancer."

The incidence of aggressive breast cancers is also twice as high in black women compared to white women. 

"The peak age at which black women are diagnosed with breast cancer is in their forties and that is the very age group the ACP has said you should not be screening," Bennett tells KMOX. "And so unfortunately, I think in their quest to provide clarity to women, which is something I applaud, I think they have inadvertently caused harm to a wide group
of women who are very important in our population."
 
Dr. Bennett was joined in writing this letter by Dr. Kate Appleton and Dr. Michelle Lee from Washington University School of Medicine. 

The three radiologists write that "as physicians in St. Louis, where almost half of our city's women are black, reducing the disparity in breast cancer mortality is a responsibility we take very seriously."