Mammogram guidelines not suited to all women

While the American Cancer Society updated its mammogram recommendations Tuesday, the guidelines "are not written in stone," a Fox Valley physician said.

"One of the key ideas here is that they are guidelines, and just guidelines," said Dr. Jack Swanson, president of Fox Valley Hematology & Oncology. "They're not ... applicable to everybody."

The American Cancer Society recommends that women begin annual breast cancer screenings at age 45, five years later than previously recommended. By age 55, the guidelines recommend mammograms every other year.

"The guidelines confirm that screening mammography is the most effective way for a woman to prevent prematurely dying from breast cancer," said Beth Brunner, a health systems manager with the American Cancer Society in Wisconsin.

The society said women with a higher-than-average breast cancer risk should receive a mammogram every year. This group includes women with a family history of the disease or who have a known BRACA1 or BRACA2 gene mutation.

"Not everyone agrees on this," Swanson said of the new guidelines. "It's going to be confusing."

One person who doesn't agree with the recommendations is New London's Sharon Guyette. She's had an annual mammogram since the age of 40. In January, she was diagnosed with invasive ductal carcinoma.

"By next year, who knows where this cancer would have been," Guyette said.

Guyette, 65, said she had a lumpectomy and 10 rounds of radiation, twice a day, for a week. She did not have chemotherapy, and was given supplements.

"I believe (mammogram) screenings should be earlier," Guyette said. "I don't think this guideline is good at all."

One of the reasons for later screenings, Swanson said, is because younger women have denser breasts, making it harder for mammograms to identify possible tumors. He said the guidelines might also help cut down on "false positives," where mammogram findings show something that isn't there.

"Some patients really dread the mammogram experience," Swanson said. "It can be painful, and the callback thing is a real, real difficult thing for the patient to go through."

In 2011, Kathy Privatt, an associate professor of theater arts at Lawrence University, went in for a routine mammogram. She got a callback, did a self-exam and found a lump, later determined to be a tumor about the size of a breath mint. She had a lumpectomy, and her cancer was in an early stage but was moderately aggressive.

"In reality, we could have waited six months and there would have been no significant difference in terms of how big it was, how much it spread," said Privatt, who was diagnosed in her late 40s.

She had four rounds of chemotherapy and 10 weeks of radiation. Today, she takes an estrogen blocker. Privatt said she supports the guidelines because she believes they could lead to lower health care costs and more frank discussions about the disease.

"I feel like these new conversations are trying to take the whole topic of breast cancer out of the realm of a big, fat scary thing we don't even want to think about to a reality in our world," she said.

Because researchers have to sift through data of thousands of patients, Swanson said guideline are difficult to construct.

"We don't know what causes any cancer, frankly," he said. "Without that knowledge, it's very hard to make a guideline across the board."

Swanson added that mammograms, like any test, carry risks. But he said the best approach is for patients to discuss all factors, including personal and family medical history and breast makeup, with their doctors.

"Women starting at age 40 should talk with their health care provider about a screening plan," the American Cancer Society's Brunner said. "This isn't a one-size-fits-all recommendation."

Ethan Safran: 920-993-1000, ext. 426, or esafran@gannett.com; on Twitter @EthanSafran