Maine Doctors, Patients Wrestle with Conflicting Mammogram Recommendations

Oct 26, 2015

Last week, the American Cancer Society changed its guidelines for breast cancer screening.

The update reflects the current thinking around when and how often to get screening mammograms. But the change also means that there are now multiple sets of guidelines for Maine women and physicians to consider, and that could cause some confusion.

For more than 20 years, Maggie Gillis of Buckfield has dutifully gone in for regulator breast cancer screenings.

"I started getting mammograms in my late thirties after having children," she says. "That was the recommendation at the time."

But about five years ago, Gillis decided she would stop her annual ritual.

"I got a little concerned about the accumulation of the radiation," she says.

And seemingly ever-changing guidelines, Gillis says, have also become confusing.

Maggie Gillis
Credit Patty Wight / MPBN

In 2009, the U.S. Preventive Services Task Force caused considerable controversy when it recommended that women begin mammograms every other year starting at age 50, rather than 40. And the new guidelines from the American Cancer Society move closer to those very recommendations.

Local spokesman Brad Waddell is a surgical oncologist at Eastern Maine Medical Center.

"The standard recommendation is now to start annual screening mammograms at the age of 45 and do that every year till the age of 55, then consider a transition to every other year," he says.

Meanwhile, the American Congress of Obstetricians and Gynecologists recommends women start annual mammograms even earlier, says spokesman Dr. Christopher Zahn.

"For average-risk women, it's starting at age 40, and to do those annually," he says.

That means that there are now three sets of recommendations, each with a differing starting point — age 40, 45 or 50. So, what's a woman supposed to do?

"I think it really can be simplified," says Dr. Tracey Weisberg, a medical oncologist at New England Cancer Specialists.

She says it's important to remember that these guidelines don't apply to women at high risk — those with a family history of early onset breast cancer, or breast-cancer-related malignancies. Those women should be screened earlier, often using a more sensitive device such as an MRI.

For women at average risk, Weisberg acknowledges that it's a bit more complicated.

"For most of us, sadly, breast cancer is a disease of aging," she says.

Breast cancer is more common in women in their late 50s through their 60s and 70s. And one way to measure a mammogram's effectiveness in a particular age group is to measure how many women need to be screened in order to save one life.

For younger women, the screening reaps fewer results.

"In the 30s and 40s, the number of women you have to screen in order to fish out that one or two with cancer is very high," Weisberg says.

Meaning mammograms are not as effective in that age group. And some physicians — such as Dr. David Newman, editor-in-chief of The NNT, a website that rates medical therapies and diagnostics based on scientific data - take the argument a step further.

"If you're making a broad recommendation, you'd have to say screening mammograms doed more harm than good as best we can tell, based on our best trial data," he says.

One harm, says Newman, is that mammograms can lead to overdiagnosis of breast cancer.

"Identifying cancers that we don't know what to do with, and in many cases look like would never have been dangerous and wouldn't have done anything to you, and maybe your body would have beat on its own," he says.

Even supporters of regular mammograms concede that that there are issues, including overtreatment, that are real.

"It really is probably naive of us all to believe a simple X-ray can level the playing field and save a life," Weisberg says. But she believes these screening procedures still have value, particularly for certain women.

"There are many women who do not have breast awareness, and they do not touch themselves, and they rely on their mammogram," she says.

Ingrid LeVasseur of Inner Image clinical thermography.
Credit Patty Wight / MPBN

But all the physicians interviewed for this story agree that the guidelines around mammograms should be just that — guidelines. That women need to learn about their personal risk factors, and engage their doctors in a conversation about the best plan for screening. And many physicians support research on alternatives methods such as thermography.

"With thermography, we're looking at the metabolic process going on — so is there abnormal heat being produced or not?" says Ingrid LeVasseur, owner of Inner Image clinical thermography in Falmouth. She uses an infrared digital camera, mounted on a tripod, to create a colored topographical heat map of a woman's breast region.

LeVasseur says abnormal heat can be an indicator of a more significant issue, and recommends annual images.

"What the doctors are looking for not is not just the heat, but the patterns the heat makes," she says. "And do those patterns stay stable?"

Thermography is not intended to replace mammograms, LeVasseur says, but to supplement them. Gillis is now primarily using thermography.

In the meantime, a Breast Cancer Screening Consensus Conference will convene in Washington, D.C., this January, with a goal of creating a uniform guideline for mammograms.