Jennifer Lowe cried when she heard a government panel had recommended that women wait until age 50 to get their first mammograms.

“This is a huge mistake,” the Billings woman said.

Lowe was 43 when a routine mammogram detected a suspicious mass in her breast.

“I know had I not had that mammogram, I would be dead,” Lowe said.

Instead, she had a mastectomy and chemotherapy. A year later, she is healthy and has become a mentor to other young women with breast cancer.

“All the gals I’ve been in contact with are completely frightened about this decision,” she said.

On Monday, the U.S. Preventive Services Task Force released new guidelines suggesting healthy women get mammograms every other year beginning at age 50.

For years, women have started mammograms at age 40 and had one every year, a practice that the task force endorsed as recently as 2002.

But now the group, a panel appointed by the federal Department of Health and Human Services, says there is not enough evidence to show that earlier and more frequent screening is worthwhile.

“It’s probably a situation of economics,” said Dr. Thomas Purcell, medical director of the Billings Clinic Cancer Center. “You spend so much money for one life. That’s the way these economists look at this. Does it make sense to do so much screening on an entire population when it detects so few cancers?”

Yes, said Dr. Mitch Gallagher, a radiologist at Eastern Montana Radiological Associates in Billings, an affiliate of St. Vincent Healthcare.

“We do not support this at all,” Gallagher said. “If you look at the death rate from breast cancer prior to 1990, before good screening practices became available, it never budged. Since 1990, the mortality rate has dropped 30 percent.”

Some of the reduction is due to better treatment options, but much of it can be attributed to mammography, Gallagher said.

According to the task force, annual mammograms prevent one cancer death for every 1,904 women age 40 to 49 who are screened for 10 years.

Although it certainly matters to the one person whose life is saved, the rate does not carry enough statistical weight to warrant blanket screening in that age group, the task force reasoned.

What is the harm in screening so many women when only a few are found to have cancer?

As the number of screening tests increases, so does the number of false-positive results. Those lead to unnecessary follow-up testing, which costs money and causes anxiety.

“There is a subset of women who clearly need these mammograms,” Purcell said. “The question is, who are they? How do we parse through that? Right now, I don’t think there’s a good way to do that.”

Women who have a family history of breast cancer or other risk factors still should be screened at age 40 or earlier, according to the task force.

But some women who do not have any risk factors will develop breast cancer in their 40s.

Since the beginning of 2008, Gallagher’s office has used mammography to diagnose 52 women age 40 to 49 with breast cancer.

It is impossible to know if or how those cancers would have developed had those women waited until age 50 to be screened.

“You do not know the character of breast cancer unless it’s actually diagnosed,” Gallagher said. “You have to make the diagnosis first.”

Joan Fritz is convinced that the tumor a mammogram found near her armpit would have spread to her lymph nodes had it gone undetected much longer.

“This was not detectable by touch,” Fritz said. “I had just been to see my doctor who had examined my breasts.”

Fritz, of Billings, was 50 when the cancer was diagnosed earlier this year. But she thinks women in their 40s should get mammograms.

“I just lived this,” she said. “There’s no way the government is going to tell me to wait. We’ve known for a long time to be proactive.”

 

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.