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Women Wonder: When Is It Time for Breast Cancer Screening?

4:04 PM, Oct 24, 2010   |    comments
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By Hiran Ratnayake, The (Wilmington, Del.) News Journal

WILMINGTON, Del. - Nina Pala Tigani and Michelle Harris were two of the last women experts would have expected to get breast cancer.

Tigani, 54, of Greenville was an avid walker and tennis player. As for Harris, 47, of Bellefonte no matter how late she worked, she'd drive to the gym for a step aerobics class and 20 minutes on the treadmill.

Tigani ate primarily a Mediterranean diet and rarely touched red meat. Harris ate organic salads for lunch and, to avoid pesticides, started a vegetable garden in her backyard.

Both underwent annual mammograms in their 30s and 40s, when the risk for breast cancer is low.

But they both got it - Tigani in 2002 at age 46; Harris in 2008 at age 44.

That's also where their differences emerge.

While a mammogram caught Tigani's cancer, a similar test missed it in Harris.

Their differences also point out how the effectiveness of mammograms - or the lack of it - has created two camps during the past year. Some advocacy groups and medical societies support annual mammogram screenings starting at age 40, while another group says the screenings should begin at age 50.

The divide started when the U.S. Preventive Services Task Force - a little-known, federally funded group of experts in preventive screening - altered its guidelines for breast cancer screenings from age 40 to 50. After a public uproar, the task force tweaked its recommendation to say that screenings should be an "individual decision" before age 50. But it sticks by its position that the net benefit under age 50 is minimal.

Even now, as events are being held to mark National Breast Cancer Awareness month, women continue to hear two opinions.

Vicky Tosh-Morelli, director of information services for the Delaware Breast Cancer Coalition, often is asked when women should get screened.

"I think the uproar has certainly settled down but there's still some confusion," she said.

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Tosh-Morelli's organization, the state's leading patient advocacy group on the disease, was besieged with phone calls immediately after the task force's new guidelines were announced last November.

"The response was overwhelmingly the same," Tosh-Morelli said. "They were saying, 'I don't care what this task force says, I'm going to get it anyway.' "

That was the opinion of Michelle Irwin, 40, of Newark, who visited a coalition booth Friday during a health fair in Stanton. Irwin said she's undergone several mammograms. One showed something suspicious, but a follow-up visit revealed that nothing was wrong. Even after that experience, she'll keep getting them.

"I've had other friends who told me that every time they went to get a mammogram it found something wrong and they finally stopped getting them because of all the anxiety," she said. "But it's worth it to me to continue to get it."

The task force, established in 1984, is made up of 16 medical experts, mostly doctors. Never has it experienced the backlash that came with the mammograms, said Dr. Ned Calonge, chairman of the task force.

The task force's recommendations were based on the calculation that 1,904 women in their 40s would have to undergo mammograms for a decade to prevent one breast cancer death. In comparison, 1,339 women in their 50s would have to undergo mammograms for a decade to save a life.

Also factoring into the recommendations was the belief that there's a much greater risk of 40-something women getting a mammogram that tells them they have something suspicious that turns out to be benign, Calonge said. It's the same error that Irwin experienced, known as a "false positive."

False positives are estimated to occur in half the women who get a mammogram in each year of their 40s. The errors can lead to needless anxiety, painful needle biopsies and, in extreme cases, unnecessary surgical procedures and intensive medical treatments.

"We never said that mammograms didn't work," said Calonge, also a family practice doctor and chief medical officer of the Colorado Department of Public Health and Environment. "But you're screening 1,904 women in their 40s to save one life and you're getting a lot of false positives and a lot of unnecessary biopsies."

Patient and doctors organizations that balked at the new guidelines don't dispute the data. Instead, they say it's worth all the false positives and unnecessary biopsies to save that one life.

"Mammograms may result in call backs for further studies, and women need to know that," wrote Dr. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society in a recent blog post on the subject. "But frequently, it is the mammogram that gets the woman to the treatment."

Tigani considers herself that one life that a mammogram saved.

She started getting them annually at age 30. Friends told her she was wasting her time and health benefits.

"I always thought, 'What the hell, it's better to know than not to know,' " Tigani said.

After a mammogram confirmed the cancer she said "a shock went through my body."

She underwent chemotherapy, a double mastectomy and received breast implants. She wants her 14-year-old daughter, Jamie Tigani, to start getting mammograms at age 25.

The Delaware coalition continues to recommend that women get screened at age 40. But the coalition also provides links to organizations that side with the task force.

Dr. James Gill, a family practice doctor in Wilmington, believes most healthy women should start getting screened at 50. For women under that age, he explains the pros and cons.

"I think people have a false sense of the accuracy for all screening tests, not just mammograms," Gill said. "You have to explain to the person what the chances are that the mammogram is going to help them personally. I'd say for women in their 40s, the chances are pretty low."

The (Wilmington, Del.) News Journal is owned by Gannett Co., Inc., which also owns USA TODAY.

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