Chicago researchers weigh in on Mammogram firestorm

November 20, 2009

Among this week's Least Popular Americans, along with Rev. Fred Phelps, Rex Grossman's dad and FAA tech support, we might count the United States Preventive Services Task Force. That group released new guidelines on screening mammograms, recommending that women start regular mammograms at 50 rather than 40, and get them every two years instead of annually. The change has been met with a jet of venom from advocates, many medical professionals and much of the general public. Chicago has an interesting place in this controversy -- we've been hearing the national dust-up all week, and now here's a look at what this means for our part of the world. For starters, Chicago has an especially glaring race gap in breast cancer deaths: black women with breast cancer are more than twice as likely to die of their disease than white women . Tune in this Sunday at 5pm for a half-hour special based on the series. The Metropolitan Chicago Breast Cancer Task Force has been pushing mammography as a crucial tool in closing that gap. They wrote a letter this week calling the new recommendations "misguided."

Black women, in particular, have higher rates of breast cancer diagnosed between the ages of 40 and 50 [the American Cancer Society says it's up to age 45. -- GS] compared to white women. The recommendation for beginning screening at age 50 reduces the opportunity for this group of women, who often times have more aggressive breast cancers, to have their breast cancers detected at the earliest stage, which would provide them with the greatest opportunity for long-term, disease free survival.

It's worth noting that the new recommendations include caveats for women at higher risk for getting breast cancer, who should continue to get screened more often. One could argue that being black and in Chicago puts you at higher risk -- if not for getting cancer, then for dying from it. But even if you interpret it that way, these docs say the nuance will get lost amid the confusion of conflicting messages. Another expert, Richard Warnecke, who heads up the Center for Population Health and Health Disparities at UIC, was a little less critical of the change. He says the benefits of mammography for women between 40 and 50 have always been a little fuzzy, and this change actually represents an incremental rather than fundamental shift. He says it doesn't diminish the importance of early detection. But it means that for some women, the best course of action is regular visits with their doctor, not necessarily getting mammograms every year. A number of medical societies have weighed in against the new recommendations as well, including (as of yesterday) the Chicago-based American College of Surgeons. Interestingly, the American College of Obstetricians and Gynecologists also opposed limiting the population that should get screened for breast cancer "¦ and then just today, they took the exact opposite position on screening for cervical cancer. I expect this will not be the last change we see in guidelines for cancer screening -- screening whole healthy populations is a very blunt instrument, and as more data and evidence come in, scientists will refine their recommendations. The changes in message are frustrating and confusing for us lay people, and sometimes they're flat-out off-base, but health professionals say this is the way that medicine stumbles toward progress.

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