New breast cancer guidelines highlight health care split

The reaction to new government guidelines this week that call for fewer breast cancer screenings highlights an already spirited schism on the issue.

On one side are women's health organizations, doctors and breast cancer survivors who stand by the status quo - annual mammograms starting at age 40.

On the other are experts and activists who view mammography the way some experts view the PSA, the prostate cancer screening exam for men: a test ripe with flaws and a source of unnecessary anxiety.

>> Read about the government's controversial stance on the importance of mammograms

>> View our photo gallery of celebrity cancer survivors

Hillary Rutter, director of the Adelphi NY Statewide Breast Cancer Hotline and Support Program, said she was stunned when she read the report recommending that mammograms begin at age 50, and that women in their 40s can skip the exams.

"We are going to continue to advocate for yearly mammography screening for all women 40 and above," Rutter said. "We see the new recommendations as a great excuse for the insurance companies to say they're not going to cover it."

The government's directives, released Monday by the U.S. Preventive Services Task Force, emphasize that women aged 50 to 74 who are of normal breast cancer risk - the vast majority of women in the United States - need the exam only every other year, rather than annually. Women 75 and older, the guidelines say, don't need to be tested. The task force is highly influential in determining insurance policy.

Insurers and Medicare now pay for screening mammograms, which cost between $100 and $150, and advocates such as Rutter say it is unlikely that insurers will cover a procedure that does not carry approval from the task force.

Susan Pisano, a vice president with America's Health Plans, an association representing 1,300 companies that provide health insurance to an estimated 200 million people in the United States, confirmed the panel's recommendations will influence coverage.

Pisano said mammograms will still be covered, but doctors "will not automatically recommend a mammogram if you are a woman in your 40s."

Dr. D. David Dershaw, director of breast imaging at Memorial Sloan-Kettering Cancer Center in Manhattan, said the breast cancer death rate has fallen, largely because of routine screening, beginning at 40.

"I hope this is something the public disregards and takes guidance from a conservative organization, the American Cancer Society, which is encouraging women to have a mammogram every year starting at age 40," Dershaw said.

Survivors also are mystified by the task force's recommendation discouraging breast self-exams.

"It makes me angry," said Angela DiPietra of Elmont, who found her own lump at age 35, which led to a mammogram and successful treatment for cancer. "There are so many women whom I've met who have been helped through self exams."

But many national breast cancer advocacy groups - the National Women's Health Network, SHARE and Breast Cancer Action - are siding with the new recommendations.

Barbara Brenner, who heads Breast Cancer Action, said she was surprised the government had taken a clearly unpopular stand.

A breast cancer survivor, she said her group had been "saying for years that there is no evidence that routine screening of women at normal risk for breast cancer aged 40 to 49 saves lives. Now the Preventive Task Force has caught up with us."

>> Read about the government's controversial stance on the importance of mammograms

>> View our photo gallery of celebrity cancer survivors