I have read and listened to all of the calls and emails that have come into the Foundation since I first appeared on TV talking about the new United States Preventive Services Task Force guidelines. It’s very distressing to me that many of you think that I’ve abandoned you and your concerns.

I have spent my entire career working in the breast cancer field. I want to find an end to this insidious disease. If I thought that these guidelines would harm women, I’d be the first person to speak out.
These guidelines are just that—guidelines. The guidelines aren’t saying that women between 40-50 should never have a mammogram. Women under 50 who are high risk should have a more intensive screening program that includes mammography. Women younger or older than 50 who see or feel a change in their breast should have a mammogram or ultrasound so that the problem can be diagnosed.

What they are saying is that a careful review of the scientific evidence shows that in younger women of average risk the risks outweigh the benefits of routine screening. Understandably, this is a shocking statement to hear, as it completely contradicts the “women should get an annual mammogram starting at age 40” recommendation that we’ve been hearing for the past decade.

What many people don’t know is that this recommendation to extend screening to women under 50 was fraught with controversy. The decision was not based on evidence; it was based on political will. Virginia Ernster wrote an excellent article about this in the American Journal of Public Health in 1997.
Since then, we’ve become even more focused on the need for health care that is evidence-based. This is not just because of the cost factor. (The evidence may show that a more expensive drug or procedure is better, and that’s what we will need to then follow.) It’s because studies have shown us that treatments or tests we thought would be more effective were not. That’s why research is so important.

The problem with mammography in women under 50 is that it doesn’t work very well. Breast tissue is dense in young women and appears white on a mammogram. Cancer also appears white on a mammogram. This means that trying to find cancer on a young woman’s mammogram it is like looking for a polar bear in the snow. As a result, mammography misses many cancers in young women. And not only does it miss many cancers– giving a false sense of security–it also finds many things that are NOT cancer but need to be checked out through biopsies or other tests. In addition, the risk of the radiation is higher in younger women and cumulative so that the additional cancers caused by the radiation have to be weighed against the ones found by the test. It is not as simple as we would like to believe.

The guidelines do not say women can never have mammography under 50 or even over 75, another change that seems to have been overlooked. What it says is that women need to stop and weigh their own risks and beliefs and talk to their doctor and make a conscious decision about the way they personally want to go.

Additionally the guidelines do not say “never do breast self exam or touch your breasts again.” The data shows that formal four-position 20-minutes breast self exam is no better than the usual poking around we all do. The guidelines continue to suggest that women be aware of their breasts; they just do not recommend that physicians spend time training women in formal BSE. Most cancers in women under 50 are still found by the woman herself and not screening mammograms.

Finally, another point that has been missed by the media is the recommendation that mammography be done every other year in women 50-75. This too is based on data. The magic of 50 is menopause. As a woman’s hormones wane her breast tissue becomes less dense and the mammograms become easier to read, shifting the risk benefit balance.

The real issue is not whether mammography can find cancers but whether it can find them at a point that will make a difference in the outcome. The problem is that it is really the ability to find all cancers early that is being questioned. We now know that there are at least five different kinds of breast cancer and that some are so slow growing that it doesn’t matter when you find them, they would never kill you. Others are so aggressive that they will have spread before you can see them on a mammogram. It is only some of the kinds where you can make a difference with screening and it is mostly in women over 50.

What I hope these guidelines will do is push doctors to have a conversation with their patients about the risks and benefits of mammography so that women can make a decision that is right for them. If, knowing the risks, you want to have a mammogram, that should be your choice. But you should also know that mammograms are not all that good at detecting breast cancer in women under 50, so that you can be alert for any changes you see in your breasts. If you are high risk, you and your doctor should develop the appropriate screening program for you. Depending on your age, and your breast density, this might also include MRI. And no matter how old you are, you should see your doctor if you see or feel any changes in your breast.

I had nothing to do with formulating these guidelines but if you look back at what I have written over the years, it is consistent with what I am saying today: mammography is not a good tool for finding breast cancer in younger women and we need to put our efforts to finding something better. I try to do just that and have been involved in the development of ductal lavage, which washes out the milk ducts and collects cells. While we hoped it might be a good early test it has not been found to be as accurate as we had hoped and is now used only as a research tool. At the Foundation, we continue to both fund and do research to find something that will work better than mammography, especially in young women at risk of getting breast cancer.

Also, to be clear, I have not been influenced or received any donations from any insurance companies, nor have I been bought off by our Federal government, nor do I think that these guidelines are part of a government conspiracy. These guidelines come from a respected independent group that issues similar reports on a regular basis. Their last set of recommendations was in 2002. These recommendations are based on an extensive review of the data and took years to develop. It is just coincidental that they came out during the health care reform debate.

I hear your anger. I’m angry too. But not for the same reason. I’m angry because we’ve oversold the benefits of mammography to the extent that there is no longer room to look objectively at the evidence. I am angry that we still don’t know what causes breast cancer and how to prevent it. I started the Army of Women to channel that anger into positive action. I ask that you also channel your anger and frustration into helping us keep breast cancer from going on to another generation! We can do it. We can go beyond finding cancers that are already there to ending this disease all together. But we can’t let ourselves be distracted from the goal. We can agree to disagree about mammography screening guidelines, but we can not let up the pressure and efforts to stop breast cancer once and for all!

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163 Responses to A Message from Dr. Love about the New Mammography Guidelines

  1. Chris says:

    Dear Doctor:

    I began my discussions with you on this site assuming you are a good professional with a heart to help women fighting this terrible disease.

    Now after reserach your website and re-read all your comments, my opinions are changed. I think you are very ignorant in making irresponsive statements like mammography does not work for women in their 40′s and radiation may cause more cancers from screening.

    Here are more questions to you if you have any answer (you have not answered any of my questions from before):

    1. What your research foundation has done to help women? You have received donations and what new methods you have helped to invent to detect or treat breast cancers? From what I can find, nothing is the right answer;

    2. Other groups like ACS and Komen foundations have promoted screening for early detection. It worked, as even the task force agreed in their reports, for women from 40 and older. I am pround of contributions to those organizations who truly care and know ehat they are doing;

    3. What are exactly your motives? Do you want people to contribute more to your effort to find the cure for breast cancer? that’s fine but it does not make any sense for you to ask women to not take advantage of the best tools they have available today. Since you have nothing to help them today if the breast cancer is detected too late.

    This is my last comment here to you. Please remember science and medicine are about common sense, open mind, and heart.

  2. Sydney says:

    Thank you so much for this post. I have been shocked by the knee-jerk reaction the media is giving to these new guidelines. It makes perfect sense to me. My best friend had 2 biopsies (that proved to be nothing) in her 40′s due to false positives. My other friend that did find breast cancer due to mammography was 1) in her 50′s anyway, and 2) in the high-risk group (mother had breast cancer) so would have been screened in her 40′s anyway based on the guidelines.

    I prefer not to expose myself to additional radiation, anxiety, and possibly additional invasive tests and now feel comfortable waiting until 50 for my next mammogram (I’ve already had 2 in my 40′s).

    I wish people could step back for a moment and see how sensible this all really is.

  3. David Heltzel says:

    Dr. Love,
    After looking at my #4 posted, I apologize, I’m sure you dedicated a lot of hard work to your research and will continue to so and hopefully find a better screening tool.

    One last thing though, I would be far more cautious about implicating radiation from screening mammograms as a harm. There is only evidence to show that the actual, realized benefit from the radiation is far, far greater than the theoretical harm.

  4. Liz says:

    I, too, am distressed by these new guidelines, because I know in my heart that insurance companies will use this “recommendation” to deny screening mammograms for younger women. Cancer is a horrendously expensive disease, and insurance companies are already using any excuse they can to deny people coverage, especially with pre-existing conditions. (There IS a reason there is a big debate on health care right now!) I am one of those “low-risk” women who was diagnosed with Stage 2 breast cancer when I was 39. I found the lump myself. Almost 5 years later, I am stage 4, but thanks to tons of research and newer medicines, I am continuing to live a full life. Can I also just say how very tired I am of the exploitation by marketers who cover their products with “pink ribbons,” so-called “fund raising,” which really means making tons of money for the company itself. It always comes back to money, to the bottom line. Dr. Love if you believe these recommendations won’t be used against us by the insurance companies, I agree with others who think you are mistaken and that you have underminded your own work.

  5. BK says:

    The fact that MDAnderson stands by the previous guidelines says it all for me. I can’t be at SABCS this year, but wish I could to hear the ensuing debate with you about this and hear the scientists and advocates lambast this Task Force and your support of it.

    This IS about rationing. For the meager 15 or 20% who the study(ies) claim benefit in their 40s from mammo, who could lose their life by waiting until they are 50, this is rationing. The technology is not that expensive and is an important diagnostic tool, though it is obviously not the be all end all. We do absolutely need more advanced diagnostics, but we are not there yet, are we? And until we are, we need to use every tool necessary to DX women as early as possible. I am 50, was DXed by digital mammo at 44. I am in a young survivors support group of over 250 women. 75% of them are in their 30s and 90% of those in their 30s were DXed BY MAMMOGRAM or DXed by annual GYN appt and confirmed by mammo followed up by ultrasound and biopsy.

  6. Christine says:

    I found my “lump” at 29. 1 year after the birth of my daughter. I then went to my GP. He dismissed it saying ” you r too young for breast cancer, lets keep an eye on it.” So I did. 7 months later it grew to the size of a large lemon! Very aggressive, Her2+ breast cancer. It was discovered by a mammogram. If I had not listened to that little voice in my head or better yet, the “new” guidelines……….I’d be dead. I bought your book when I was first diagnosed, now Im going to burn it. You have left a very bad taste in my mouth, you should be ashamed at you comments.

  7. Kimberley says:

    This report and the implications are devastating! Seven years ago my mammogram showed calcifications. I had a biopsy and experienced the “angst” that everyone is saying is such a problem. Five years later, at age 45, I was diagnosed with breast cancer that was found through a routine mammography screening. If these new guidelines had been in place, I would not have had either mammogram and I might have died of breast cancer.

  8. Stephanie - 9 yrs stage IV BC says:

    Dr. Love,
    #1 Please DO NOT insult us by starting your “dialogue” with mortality rates from papers SIX and TEN years old. This is BEFORE Herceptin and better homone therapies were in wide use. I know, Herceptin has saved my life, since I started on it when stage IV. One less number on the mortality rate.

    #2 Tell us how you do not stand to benefit from a change in breast screening/diagnostic techniques when you/your research organization are the major force behind the Annual Intraductal Approach to Breast Cancer Symposiums?

    The “intraductal approach” has not become mainstream. WHY? What is the holdup?
    The 6th such symposium was held just Feb. of this year.
    Perhaps by supporting the change in guidelines, which has caused doubt to be cast on all that was recommended before, you expect the door to open for new methods to be rushed out to fill a gap.

  9. Pam says:

    Sydney, would you feel the same way if one of the two mammograms you had in your 40′s showed you had breast cancer? As for your friend and her negative biopsies, I was told 80% of biopsies are negative, but I fell into the 20% that were positive. Do you think that means no lumps should be biopsied on anyone under 50 or better yet, abandon biopsies altogether? NO of course not! I can’t believe you can’t see how ridiculous these NEW guidelines are.Worse yet,I can’t believe Dr Love can’t! The new guidelines are one GIANT LEAP BACKWARDS for women!

  10. Susan says:

    Oh my gosh, I FINALLY get it. I’ve been reading about the new guidelines for 3 days now and just TODAY I understand what they were attempting to say about self-examinations. They aren’t saying to not do them, they are saying that any method you use is just as good as any other. So why in the world wouldn’t they just say those words? I think the entire problem here is that a bunch of PhD’s and MD’s do not know how to correctly communicate what they are trying to say to the rest of the world. Therefore, it’s completely misunderstood by everyone, and quite rightly so. If they were, in fact, saying that virtually nothing should change for women, then WHAT WAS THE POINT OF THE STUDY? The only point you can conclude on is that saying all this stuff will confuse almost every woman on the planet, AND cause insurance companies to act differently due to that confusion. Again I say – THIS IS A MESS.

  11. Becky says:

    Dr. Love,

    I understand the reasoning for women in their 40′s, with no past family history or any other health risk rethink having a mammogram due to the dense breast tissue in younger women.When a women turns 50 due to menopause and age, her breast tissue is less dense and easier for a radiologist to read. If the mammogram is easier to read, why the guideline of every two years? I thank you for your continued diligence in fighting breast cancer.

  12. Sydney says:

    Pam:

    I’m not sure why you think I don’t think biopsies should be done, perhaps I was unclear in my comment.

    Let me ask you a question. Why don’t we start routine, annual mammograms at age 30, or even age 20. I’m sure we could save at least one more life, right?

    And to Christine, no one is saying if you find a lump you shouldn’t go get a mammogram–where are you getting that?

  13. Laura says:

    How many people died of false positives – oh maybe that’s a false death. As far as I can tell no one has died from anxiety.

  14. Lisa Burkhalter says:

    Dr.Love,
    I’ll tell you what anxiety is. It is being diagnosed with stage 4 breast cancer when it could have been caught at stage 1. Early detection is the most important tool right now in this fight, it gives us a chance to fight this disease. If I’m 44,no family history, doing no self-exams and not having a mammogram, how am I supposed to detect a breast cancer? Dr. Love can you please answer my question? I am very curious as to what your answer will be?

  15. Fiona Ehrnschwender says:

    I was diagnosed with breast cancer when I was 47. It was found on my annual mammogram and was very aggressive. I had no family history and the lump could not be felt. I would not be here today if these new guidelines were in place 4 years ago. I rushed to join your Army of Women, and hope you will never send me another e-mail. I guess saving lives is not your goal.
    Fiona

  16. melinda smith says:

    when i was diagnosed at 25 i had no history and no risk factors. under the new guidelines i would not have been screened. 9 months later my mother was diagnosed at age 78 because she had a routine mammogram. is it fair to my children to not have a mother or grandmother because they could not get a mammogram? would you want that for your daughter???

  17. Pam says:

    Sydney, I had my first routine mammogram when I was in my 30′s. Sadly someone I know passed away today from breast cancer. She was young,diagnosed in her 30′s, so excuse me if I don’t see where you are coming from. For the record, I didn’t say you wouldn’t approve of biopsies, in fact, I said of course you wouldn’t stop them. I was making a comparison of your thinking using statistics alone.

    If we applied your thinking (and that of Dr Love) of not doing yearly mammograms in 40 year old women, and only start mammograms at age 50, based on the “fact” that a percentage of women will need further study, it is the same as saying don’t do biopsies on anyone under 50 because most of them turn out to be negative for breast cancer. You can see how ridiculous it would be NOT to do biopsies, but still you want to stop yearly mammograms for women in their 40′s because some women have results that, after further study, are found to be benign.

    The fact that everything is based on women at “low” risk blows my mind too. Read through the comments on these articles, read comments on any breast cancer message board and see how many women were diagnosed with breast cancer who were LOW risk! I was considered low risk, I was diagnosed in my 40′s! No one in my family had any type of cancer before I was diagnosed. The point is, they don’t know what causes breast cancers so they can only guess at who is low risk. If they knew the causes, there would be cures.

    I am sorry if your logic makes no sense to me!

    Dr Love, where is the scientific study that supports your statement “In addition, the risk of the radiation is higher in younger women and cumulative so that the additional cancers caused by the radiation have to be weighed against the ones found by the test. It is not as simple as we would like to believe.”

    No one EVER said the radiation from mammograms caused cancer! All we have heard for years is how low the amount of radiation is from mammograms and how it is even less with the new technology. How can anyone know a cancer was caused by radiation from mammograms, Dr Love? Where did you get that information from?

  18. Taylor says:

    Dr. Love,

    If mammograms done on young women “cause” cancer then anyone beofre the age of 50 should not get any radiation. No dental x-rays, no ct-scans, no Chest X-rays. All of the former emit higher doses of radiation than the current mammograms. Also no one younger than 50 should fly in a plane since you do get a small dose of radiation during each flight.

    One other radiation source that should be removed. All of the radiation that is given to all cancer patients. We wouldn’t want to add to their cancers while curing them. Stop throwing the baby out with the bathwater. We have to work with what we have today and try to keep our collective heads out of our asses.

  19. Sydney says:

    So as I asked before, why not issue guidance that calls for routine mammograms at 30 or at 20, why start at 40?

  20. Susan says:

    Dr. Love,

    I think the saddest thing about this entire debate is that women don’t have any more real answers about breast cancer and how to detect it or cure it. How can I tell my daughter when she turns 40 not to have a mammogram when her mother found her cancer at 53 with no symptoms, no lump, and no history by a mammogram. Unfortunately it was stage three when they found it. I pray by the time she is 40 research will tell us what we need to know, but it certainly seems like that men now have so many tests and effective measures for their specific cancers, ie prostate cancer but once again women are behind the times and get the short end of the stick.

  21. Chrysti says:

    You said …These guidelines are just that—guidelines. Women under 50 who are high risk should have a more intensive screening program that includes mammography.

    I say… We KNOW the guidelines influence people, doctors and insurance companies. The guidelines say only those at RISK should have mammograms before 50. Go to the boards to see how many under 50, NOT at risk (according to current guidelines) women had breast cancer and would have had much more severe treatment or died if they waited. I actually think the risk guidelines need changed (fertility drugs, family cancers in general – esp. colon, being thin premenopause, high estrogen, etc). But still many healthy, exercising, breastfeeding, vegetarians with no family cancers get it … look at the posts. Some cancers can’t be felt, some cancers can’t be seen, but the combination is what works.

    You said … What they are saying is that a careful review of the scientific evidence shows that there is no data to support the idea that the benefit of mammography outweighs the risks for women between the ages of 40-50.

    I say… Risks? How about the risk of finding your cancer late so you must endure chemotherapy, side effects from the chemotherapy for life, higher chances of it coming back, being stage IV with no cure, etc. Statistics can be sway to make a point. We all learned that in high school. Hear the voices of those who are living because it was found before they were 50.

    You said… I am saying today: mammography is not a good tool for finding breast cancer in younger women. Yes, it is the best tool we have.

    I say… Look at ALL the under 50 people with dense breasts it helped. Again, do you not hear their voices? It might not work great but as you said, we are not offered anything better yet.

    You said … Young women’s breasts are more sensitive to low dose radiation and starting yearly mammograms at 40 will cause as many breast cancers as it will find.

    I say… I don’t’ like radiation either but I don’t think today’s radiation is causing death but NO mammograms for those not in “risk” category will.

    You said… The real issue is not whether mammography can find cancers but whether it can find them at a point that will make a difference in the outcome.

    I say… Hmmmmm, at what point does it make a difference? When you can catch it early enough to avoid drastic surgery, avoid loosing your hair to chemo, avoid long term chemo side effects, avoid a young child losing their mother, avoid it coming back which causes death (these are things that cause real stress)! Yes, this is what early detection can do. What day exactly does it go from Stage I to II to III to IV? The answer depends on the cancer and that day is not known. OncotypeDX has enabled many to avoid these things. They talk about 5 year survival rates. That is not what they need to look at. We know that ER+ cancer (most common type) can come back many years (10) down the road. The higher the stage of cancer the higher the chance it comes back. There is no cure if it comes back.

    You said… It is a complicated issue and we vastly over simplify it when we attribute all advances to screening.


    I say… Advances in treatment come in to play AFTER screening / BSE. You have to find the cancer first. It is that simple.

    You said…As to BSE, the studies are clear that women and find their own cancers but that it is usually not doing formal four position BSE but rather through the normal poking around we all do. What the guidelines say is that to have doctors teach formal BSE is not useful. They do NOT say “don’t ever touch your breast again”. Women younger or older than 50 who see or feel a change in their breast should have a mammogram or ultrasound so that the problem can be diagnosed. And no matter how old you are, you should see your doctor if you see or feel any changes in your breast.

    I say… What I have read they said was “BSE are of no value”. If we are not taught (I was taught in high school) then how do we know what to look for? This is where you lost a huge support base. Depending on where the cancer is, it can be found easier by different methods. The BSE and / or mammogram has saved many under 50.

    Why do you think we have become so vocal about this? It certainly isn’t selfish because the survivors have already found their cancer and we are high risk if we kept our breasts so we will get mammograms if needed. We are vocal b/c we have “lived” this hell. You don’t really “get” breast cancer until you have “lived” it. We want to protect womankind. We want to protect our families. These guidelines came to soon and were poorly stated. The tools are not good enough yet for this change. I believe that you want to help breast cancer treatment but I also believe your mind is not thinking clearly. I, and many others, are looking for a new leader of the research movement.

  22. Stephanie says:

    As another woman who was young (36), had extremely dense breasts, has no family history of cancer, no known risk factors, and had a “polar bear found in the snow storm”, I am horrified by these new “guidelines.” Mammograms saved my life. Eighty percent of women have no family history of breast cancer. So how can you determine who is at risk? To have breasts is to be at risk! Most women don’t know that, and rely on “guidelines” from people like you. And now, because of opinions like yours, countless more will die needlessly.

  23. bcat44 says:

    Dr Love – I’m so sad and outraged at your position with regard to these guidelines. They are a step backward in our fight against breast cancer.

    The best thing we have today in the fight is EARLY DETECTION. Are mammograms perfect – no – are MRIs and ultrasounds perfect – NO. Cancers are missed, false positives are found … but you know what ? I sure wish my cancer had been one of the 80% of lumps that are benign. Unfortunately mine was Invasive Ductal Carcinoma – diagnosed when I was 44 by a routine (my first ever) mammogram. I did not have a lump that was palpable – it was deep in my breast – almost at my chest wall. I have no history of breast cancer in my family – but do have increased risk since I never had children and didn’t breast feed. I feel very fortunate that my cancer was found before it had spread to my lymph nodes or worse – to other organs. If I’d have waited until age 50 to have a mammogram who knows what stage my cancer would have been – it was grade 3 on the core biopsy pathology but grade 2 on the pathology from my lumpectomy.

    I feel you’ve done a huge disservice to the breast cancer community – we do need better screening tools and even more so – we need a cure.

    I no longer trust your opinions and will be removing my name from your Army of Women.

  24. Michelle says:

    Dr. Love,

    Thank you for making the complex understandable.

    Please keep doing what you’re doing.

    -Michelle

  25. Ron says:

    Breast cancer is obviously a very emotioanl experience for anyone touched by it. Emotions run very high and understandably so.

    We all want to find out how it happens, how to detect it earlier, how to better treat it when it does occur and even find a cure!! I believe all of those things will eventually come, if the funding comes along for the ride.

    That fight needs to be stepped up and maybe this controversy over the guidelines will step up the strategy to get there.

    But what absolutely floors me is the raw emotions to the point of so many people who have made comments here and elsewhere that are so utterly filled with ignorance, mis-information, overly emotional reactions- a complete unwillingness or ability to look at the SCIENCE AND DATA- the actual evidence and studies of what has been done over the years.

    I am just stunned at how so many people criticizing Dr. Love, who is such a hero in the field and partly responsoible for sooooo many women having their lives saved by her resource and wealth of caring information.

    People need to get a grip on this issue and look at it from the sense in which it was intended: a public policy question!!!!

    The same fear mongering is taking place that we have seen in the entire health care discussion and too many people are jumping on that critical bandwagon like a bunch of nasty robotic zombie-like ignorant mob maggots.

    Are people really so stupid as to believe that those who look at the science of these studies and the very real data assoociated with it and support it, want women to just get cancer?

    And to the women who are saying they will no longer be associated with the Army of Women- How utterly short-sighted and moronic!!!

    That is as stupid as the Catholic Church saying they will no longer provide charitable and relief services to the poor and needy in Washington DC unless D.C. backs away from the right of Gays and Lesbians to marry. Yeah- they are actually making that threat.

    For all the promise the Army of Women holds in fighting the BIG battle against breast cancer- those women should be ashamed of themselves.

    Dr. Love- I- for one believe in the work that you do and the larger cause of finding the cause and eradicating the horror of breast cancer.

    And for women who still want to get their mammograms in their 40′s- then get them.

  26. Pam says:

    I’m sorry Ron, and just when did you get your breast cancer?
    Sign me ONE OF THE SHORT SIGHTED MORONIC WOMEN WHO HAD BREAST CANCER! Yes Ron, I am no longer a part of Arm of Women. I am actually a well educated woman with a background in science and worked over 7 years in research. Weigh your words more carefully Ron. Feel free to agree with Dr Love, but don’t call those of us who disagree names because we know the beast first hand.

  27. Kavita says:

    The bottom line for me is that people who support the new guidelines are willing to give up my life to save the cost and anxiety of having mammograms for the other 1899 women in their 40s. I get that. I just can’t support it.

  28. Tara says:

    Dr. Love,
    Thank you for having the courage to explain and support the guidelines as per the USPSTF. We do our patients a disservice by not explaining the limitations of all screening examinations well enough.

  29. Maria says:

    Dr. Love,

    When I heard the new guidelines I was actually thrilled and relieved. As you know the U.S. Task Force always gave mammography screening a B recommendation. It is still B for 50 an over. As a health care professional (NP) and a women who had breast cancer 6 years ago, I am glad we can finally get away from doing the routine and look for real causes of breast cancer. For the first time I am coming out (admitting I had breast cancer, never considered myself a survivor, because I did not have a cancer that would have killed me-more about that later). What I see is that maybe many of us, have been over diagnosed, over-radiated, and over treated for Stage 1, that if left alone would not have harmed us. I now have a huge risk for later complications from the radiation, and multiple mammograms. In the u.s. we over diagnosed and over treated and women are still dying of cancer. Yes, there are so many women who have aggressive disease, at any age. These women need to know why they got breast cancer. For many of us, who caught it early, not convinced that the over treatment, is what will eventually harm us. All cancers are not alike or will they kills us. In fact they may go away on their own.
    I applause Dr. Love. I remember and still feel guilty about all the HRT counseling I did as an NP, because I thought it was a good drug. After WHI, we now see how the medical field misled us. We need evidence based medicine. Dr. Love I hope there will be a clinical trial where women with early stage, could have a lumpectomy (with negative sentinal nodes, and clear margins) would be given the option to watch and wait. Any possibility? Also I’d like a clinical trial to see the harm radiation for 8 weeks on healthy tissue (tumor was .9 cm) has long-term. Why not 4 weeks, what’s the magic in 8 except for all tumor types. Doesn’t make sense.

    Again, these screening guidelines will move us away from thinking screening cures cancer, it does not. We need to advance research. The insurance fear, I do agree with.
    I hope other women like me who feel they were over-treated come out and speak out. For example, when recommended that I get on aromatose inhibitor because it would decrease my chance of reoccurence (not death, just reoccurrance) I did the math. My reoccurance rate was 7% without doing anything, 30% of 7% did not seem compelling enough, I did my own harm/benefit analysis. Women are being over treated. We need to learn more about types of cancers, and appropriate treatment. These new guidelines give women more control. This is a good thing. People are talking.

  30. Responding says:

    When I go to the dentist, my insurance doesn’t cover the $12 fluoride treatment. But I do pay the $12 and get it.

    Many angry people wrote to say that they had a family history and/or a symptom and that they were outraged that they’d have to wait till 50 for a mammogram.

    You have a history? Not routine. You have a symptom? Not routine.

    I am stunned at the people who are turning their anger toward Dr. Love.

    To all of the people who are screaming that this is not about science and even one life is worth it: where would you draw the line?

    Should we screen all men age 40 and over? I’ve heard of men getting breast cancer in their 30′s. Should we screen all men age 30 and up?

    There was a story in the news about very young girls who had breast cancer. Some without a family history. Should we screen all females age 8 and up?

    I think most people would say that screening everyone eight and up is crazy.

    So – where would you draw the line?

    Where?

    I’m not a doctor. I’m not a scientist. But, I know there’s no such thing as 0% and 100%.

    We can not prevent all car accidents.

    We can not prevent all airplane accidents.

    We can not stop all disease.

    Smart, well meaning people are working on the problem.

    If you wouldn’t draw the line at eight years old – then YOU are saying that the life of that ten year old girl with breast cancer and no family history isn’t valuable.

    If you’re angry at Dr. Love, where would YOU draw the line?

    Where?

  31. Chrysti says:

    I agree that many are over treated. That has nothing to do with diagnosis and other guidelines can be used to change treatment.

    We are emotional because we “get it”. The higher the stage it is found, the higher the risk it comes back and the more severe the treatment. There is no cure then and early death is the result. It is a step backwards plain and simple. You can find just as many studies to prove points on the other side. You can pick away at the studies and see how they got the results. They are not the “bible” or the “almighty”.

    I’m all for “green and natural” and try to bring that into my life as much as possible but we need to look at reality. The science is not there yet. The death rate WILL rise if there are NO mammograms or so called valueless BSE under age 50.

  32. Andy says:

    Dr. Love:

    You have hit the nail on the head. I think the very upsetting lesson we have seen manifested through the USPTF recommendations, is that health care reform will not happen (at least in the near future)- at least not “real” health care reform.

    So long as politics and ancedotal rhetoric saturate the health care reform debate… the move towards evidence-based medicine, which is the foundation for controlling sky-rocketing costs, will never happen.

    Thank you for your courage, your intellect, and your passion.

  33. Lisa says:

    Maria, how can you be so sure that your cancer is not life theatening? During my journey with BC, I have met more women who were diagnosed with stage 1 in their 40′s and now they are in their 50′s and 60′s and wala it’s back with a vengence in their breasts and their bones now. I always ask lots of questions and most of them say they wish they would have gone through a more rigorous treatment at a younger age. Congrats on being a 6 year survivor, but your’e not really out of the woods yet, sorry to say. Remember people are not numbers, and as a nurse I have learned that in medicine you can never say never or always, there are exceptions to every rule. I don’t mean to sound cruel or to scare you, but if you can sit here and preach that an early stage IDC is 100% non-life threatening then you are giving many women a false sense of security and that’s just not right. I urge women to continue to listen to their oncologists who are the experts with regards to their individual treatments.

  34. Ally says:

    Dr. Love,

    Thank you for being a voice of sanity, reason and compassion.

    I’ve been shocked and disappointed at the backlash that greeted these new guidelines, which have been needed for so long.

    Your comments on this blog and in news stories have brought reassurance and clarity to people who weren’t sure what to think. Please keep speaking up for what you know is right.

  35. Janet says:

    Dr Love

    As someone who grew up in the UK where mammography screening begins at 50, I would like to point out that a positive effect of recommending mammograms to younger women is that it increases their awareness of the disease and the fact that it can hit younger women too. Many of my counterparts in the UK mistakingly believe that they have little or no chance of getting breast cancer in their 30′s or 40′s since the government does not recommend screening for their age group. I always admired the US for being at the forefront of the fight against breast cancer – now I am beginning to think they really don’t have a clue and that many lives will be lost as a result.

  36. Maria says:

    Lisa,

    I agree with everything you have said. Stage I is different depending on the type of cancer. I didn’t have IDC. So treatment needs to be indivualized to the type of Cancer. Some cancers caught at Stage 1 are very aggressive and need to be treated. Other cancers are not. There are no guarantees. I am Nurse and I have no guarantee that the treatment given to me was appropriate. I believe that is the point. Women have to ask questions and make sure they are getting the appropriate treatment. It’s a personal decision. I was able to discuss my options with my oncologist. Sorry, I don’t consider my self as a survivor. I’d like to think of some Cancer’s as a chronic condtion. I feel like I was diagnosed with a condition that probably was not life threatening. Radiation however, has major risks. So more studies need to be done. All cancers are not the same. We need to learn more. I know many women who chose mastectomy without radiation, and are fine 20 years later. More research. To be honest, I would be handling my cancer quite differently if it has been aggressive, etc. Thank you for you comments. People are talking, that’s excellent. What I don’t want are people to have a false sense of security because they get mammograms every year. We need to find out why women get mild non-aggressive tumors verses the one you describe in your note. We are all different. However, the treatments are the same. I found my experience with cancer and the treatment prescribed quite primitive. Six years later, if I would get another occurance, I would do it differently–No radiaiton. If I get cancer in the same breast again, and it is a different type of cancer, I will never know if it was the radiation or true reoccurance. This is my experience, my opinion. We need to learn more from other countries, where they have more data and evidence on screening guideline.

  37. Stephanie - 9 yrs stage IV BC says:

    Maria -
    Just curious about the 8 weeks of radiation as breast cancer treatment you mention. I had 6 weeks for a very aggressive cancer, and have NEVER heard of anyone getting 8 weeks worth.

    Yes, my cancer came back. I had 8 of 18 nodes positive and 5 were basically all cancer when removed.

    Also, the idea that statistics from other countries can apply in the USA I don’t find valid. European countries are where I assume you are referring.
    They are by far smaller in area and population, and I think the general quality of the doctors is higher than the average here.

    I know France the best. I have friends there who have been getting breast MRI for as long as 8 years. These gals are thought to be high risk for some reason and the system there can afford to screen them that way. I had MRI of my breasts at a teaching medical center once my cancer was diagnosed, and the surgeon whated a better look. At age 50 I still had sense breasts. Another In Situ was noticed just prior to the surgery.

    I wish there was a better way to screen that would be fair to all who need and want it. But, I have not seen anything new offered after all this commotion was caused by the announcement that what we now have does more harm than good.

  38. Mary says:

    I am horrified by the attacks on Dr Love, who has my support for her rational stance. Dr Love, thank you for helping me understand the new information. I am a fan of your book, read cover to cover, and passed along to my sister and friends with breast cancer. I appreciate all the information on your site.

    It’s complex, folks. No easy answers, no silver bullets. Each woman needs to weigh the tradeoffs of “routine” mammograms and make her own decisions. The controversy has been out there for some time, but most women don’t know that. My nurse-practioner was shocked when I declined a “routine” mammogram last check up — she wasn’t aware of the harms: not only the cumulative radiation, but that the severe squeezing may spread an otherwise slow-or-harmless tiny cancer. If you are the woman harmed, that’s not a “trivial statistic.” Science evolves, recommendations change. We need to be flexible, active students of the science, not passive consumers. Whose body is it, anyway? And whose responsibility?

    I myself choose to take the less-is-more route. Over-medicalization is real, very harmful, and I have experienced more than I care to recount — including a pointless “baseline” mammogram at age 26 (the point was making money for the doctor and clinic).

    Why is there no outrage over the toxic stew of synthetic chemicals and radiation that causes so many of our cancers and saturates modern society? Why is prevention not taken seriously? Where is the anger over the lack of funding for women’s health, so that we have to hold bakesales and fun-runs to support basic research? Why is flawed mammography the “best” that can be offered ? Where is the research to let physicians tell the difference between small cancers that won’t do any harm and those that will become destructive?

    Meanwhile, don’t shoot the messenger.

  39. Terri says:

    I was diagnosed 4 years ago with high grade, invasive breast cancer at 43. No family history — no risk factors. Based on these guidelines there would have been absolutely no reason to think mammography was necessary. However, I can see now if these guidelines were in place 4 years ago, I’d most likely be dead by the time I reached my 50th birthday. But thats OK, right, because statistically, I’m just one person and a very small “blip” on the statistical radar. Comforting. Very comforting.

  40. I am a young woman with an elevated risk for breast cancer and I commend you for your work and for making so clear your highly rational perspective.

    I am currently living with another form of incurable cancer. I understand well the desire to hold on to the hope that our current tools for early detection will work. It is very scary when science tells us that these tools don’t work as we hoped. But the reason we raise money for scientific research is so we can trust scientists like yourself to guide us. I’d rather be lost in the forest for a little while longer while we try to find a new path than spend my time stumbling down a road which has shown to be a dead end.

    Your honesty and clear thinking is very comforting during this time of upheaval.

    Best,
    Kairol Rosenthal
    Author of Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s

  41. Dr. Love is telling it like it is about mammograms whether it is popular or not. Thank you, Dr. Love, for your honesty, concern, and dedication! It really bothers me to see her dissed and her motives impugned.

    How many women have had total mastectomies and chemo for conditions that might not have troubled them ever, especially DCIS? How many women knew they had breast cancer years before they needed to with no difference in the result? Yes, some women have their lives saved, but many fewer than imagine they have.

    The humanistic position is to let women choose based on good information and their values. Yes, I agree there should be insurance coverage. But insisting on insurance coverage is very different from insisting on a biased and harmful official recommendation to always go get a mammogram — when following such recommendations in fact causes MANY very real harms.

    The USPTF Task Force recommendations are sensible, excellent, and long overdue.

  42. Rene says:

    read Susan Sommers new book… Knock out… Read Secret History of the War on Cancer by Devra Davis – BE YOUR OWN HEALTH ADVOCATES.. Mammograms are not the tool that they should be. BRCA2 gene owner who happened to have breast cancer.. no “survival” – its gone and Pink nauseates me! PREVENTION IS KEY.. not more drugs, not more radiation…

  43. Laurie Kash says:

    Thank you for standing for what is right. Thank you for telling the truth. The response is how it was with AZT and . People were screaming for it even though it was proving ineffective and harmful. They still wanted it.

  44. Beverly says:

    Dr. Love,

    I understand what you are saying. I wish the energy and force women are expressing was directed towards better screening and even (dare I say it) PREVENTION of breast cancer in the first place.

    I was diagnosed with breast cancer last year. I was religious about mammograms and thought even though my breasts were dense, that a “clear mammogram” meant I was okay.

    I was not okay! The tumor was over 6cm and was NOT seen on screening mammogram, diagnostic mammogram, or on ultrasound. But, by the time it was this big, we could feel it.

    I was SHOCKED to find out that women with dense breast tissue are 5x more likely to get breast cancer, AND that our standard screening (mammograms) do not work well at all on dense tissue.

    I felt, and still feel, betrayed by mammograms, and by our society that led me to believe if I had a clear mammogram, that I was okay.

    YES, we need something else.

    I’ve since had a bilateral mastectomy because I did not trust that my “hard to manager” breast tissue could be managed successfully.

    People in the news are very focused recently on “false positives”. I say posh. What about FALSE NEGATIVES???

    Thank you for all you do.

    I GET IT.

    Beverly

  45. Mary Boegel, M.D. says:

    As a family physician licensed to practice in both the United States and Canada, I always questioned the recommendation to routinely screen women in their 40′s. That has not the recommendation in Canada, where screening mammograms are recommended at age 50. I have always told my patints about the risks and benefits of mammogram screening and encourage them to come to the decision that best suits them. And the same is true for my recommendations about PSA testing for men. Some people want all the information they can have as early as possible, and others don’t want any testing that is not absolutely proven to have benefit. I enjoyed reading the copy of Virginia Ernster’s article on the 1997 guidelines fiasco. Dr. Ernster was my epidemiology professor at UCSF and one of the most thought provoking teachers I met there. I appreciate your stand on making good recommendations for screening based on science, not fear. Keep working for prevention, that’s what will utimately save the most lives. Mary Boegel, M.D.

  46. Rose Bunch says:

    Dear Susan, I do appreciate all you do as you have been the fighter for breast cancer in America. I do want to say that I missed my mammogram in 2000 I was 52, my last mammogram was in 1999 I just miscalculated. In 2001 I was diagnosed with Brest Cancer had a needle biopsy, lumpectomy, 11 nodes removed, a second surgery to remove more cancer, chemo and radiation. That year they announced on the news women did not need to get mammograms too. They may not be the best way but it’s all we have now, a false positive is better than cancer. I disagree on some of these issue, due to my circumstances. Keep up your good work I do appreciate all you do. Rose

  47. Susan, you were my doctor before you left UCLA, and I’m hugely proud of everything you’re doing. Here’s what I don’t understand, and it actually has nothing to do with you, except that you haven’t, to my knowledge, ever promoted this concept.

    I believe that women with dense breasts should be pointed away from mammograms, and given the options of ultrasounds or MRIs, instead.

    Nothing is perfect, and there is certainly the chance that ultrasounds or MRIs can miss tumors. But my own experience, and the experiences of every woman I met during treatment whose cancer was discovered late, was that their tumors, no matter how big, did not show up on mammograms. In my case, the tumor was over 3 cm. and had already metastasized. Even at that size, it didn’t show up on a mammogram. But as soon as an ultrasound was done…bingo.

    Women with dense breasts should be separated out of the population that receives mammograms. Even if there is no research to back this up, ask around. Ask women who were diligent about mammograms, but their cancers were missed until, like me, they found it, themselves because their breast didn’t look right. I’ll bet you pretty much anything that those women had dense breasts.

  48. I forgot a point that I think is important to consider. I don’t think it’s an accident that this news about breast screenings comes during the national ” discussion” about health care. Insurance companies are spending $1 million per day, to keep health insurance the way it is. This news about breast screenings – and now PAP tests – is being labled “Obamacare”, further frightening people about rationing of health care. THERE ARE POLITICAL MOTIVES TO THE PUBLISHING OF THESE FINDINGS!

    If it walks like a duck…

  49. Dawn says:

    Dr. Love; Five days after my 40th birthday in 1995, my gyn found a lump in my breast while showing me how to do a BSE. Fortunately, the tumor was benign. Fast forward to March, 2009, as I was doing my monthly BSE in the shower–I found another lump in the same the breast. Only this time, I wasn’t that lucky. I was diagnosed with Triple Negative Breast Cancer, a particularly agressive form of BC, as I hope you and your readers know.

    Interesting note: less than five months earlier, I had a CLEAN mammogram. My first mammogram after my discovery of my TNBC showed a second tumor growing, which also biopsied for TN. What shocks me is the blithe recommendation that women just not do anything until “the guidelines” tell them to. If I had not been doing my BSE, the gods know how bad my cancer would be and how much lower my chances for survival might be. For the record, I am a healthy, 54 year-old Yogini, vegetarian, non-drinking/non-smoking with NO family history of breast cancer. If I were younger and followed these guidelines, I’d probably be dead. Mammograms may be debatable based on scientific evidence, but a BSE SAVED MY LIFE, or at least help extend it. And I find it unforgivable that the “experts” are telling us to abandon them. I guess my life doesn’t mean much to “the experts”. I saved my own life with a BSE, and I am forever grateful that I took the time that month, as I had for the past 14 years, to do a BSE.

  50. Pam says:

    How does one get off the list for Army of Women? I asked to have my name removed and I just got another survey sent to me! I want NO part of a movement which will result in the death of more women.

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