M.D. Anderson doctor goes on a mammogram mission, disputing new breast cancerscreening guidelines
Dr. Therese Bevers is very busy: She's a professor in the Department of Clinical Cancer Prevention at the University of Texas M.D. Anderson Cancer Center, a medical director of the Cancer Prevention Center and she plays leading roles in multiple breast cancer prevention and treatment studies.
A native Texan, Bevers isn't afraid to voice her opinion about the progress (or what she sees a potential turn back of progress) in the field of breast cancer prevention though. In September 2009, the U.S. Preventive Services Task Force (USPSTF) released new recommendations for decreased frequency in breast cancer screening — specifically, that women aged 50 to 69 get a mammogram every two years, and that women in their 40s should merely talk with physicians about the benefits and harms of screenings, and then decide when to pursue a mammogram.
"I have concerns with both of those recommendations," Bevers tells CultureMap. "The USPSTF suggests that women in their 40s should not routinely have mammograms because the harms outweigh the benefits — but the harms that were identified were largely false positives. The concern that the breast community has is that there are false positive with any screening test.
"But I don't think you can put that on the same level as preventing a woman from dying from breast cancer."
Another identified harm was that of radiation exposure during a mammogram, but Bevers says that that "miniscule" amount of radiation is akin to the effect of taking an airplane flight from LA to Paris.
She says that if 1,900 women had to be screened to prevent one woman dying from breast cancer, "I think that's an acceptable balance for most women, because most women appreciate that a callback is vastly different from not dying from breast cancer." In essence, the "harms" identified by the U.S. task force are the psychological stress incurred by revisiting a doctor because of a potential false positive.
"The U.S. task force's study places too great an emphasis on harms and not enough understanding of the value of routine screening of women in their 40s," says Bevers. "Women would rather have cancer found at the earliest possible stage.
"I've had callbacks before, and they're not fun," the doctor says of her own personal experience. "They're not pleasant. It's anxiety provoking. It's not just getting imagery, but also possibly a biopsy. But I think that most women would say, 'Hey, if this is going to help to find something early, I'll undergo it.' "
Bevers says that data shows that previous screenings don't affect a woman's future intent to have another screening.
What's more, the task force's recommendations suggest that women in their 40s consider undergoing screening mainly if they are genetically at risk for the disease. That's poor advice, Bevers says.
"The vast majority of women in their 40s who are diagnosed are not of increased risk," she says. In fact, 70-percent of 40-something women diagnosed with breast cancer do not have a family history of the disease.
Bevers says the recommendation that women in their 50s and 60s be screened only every two years is also flawed. The U.S. study stated that screening every two years maintained almost 80 percent of the benefit of yearly screenings.
"What that's saying is that we're willing for 19 percent of these women to not to be diagnosed at the earliest stage," she says. "Why not 100 percent again?"
Bevers has always felt gravitated towards women's health. She elaborates,
I think that breast cancer is a very anxiety provoking area for women, and I think that there are a lot who, even after they have gone through evaluation, still have a lot of uncertainty as to what just happened. I always find a great deal of satisfaction in sitting down with those people and saying that their lab work was or was not benign, and then having a further discussion to help them to get to a comfortable point."
Such was the case with 66-year-old patient Laura Camp, who was diagnosed with an early stage of breast cancer on Wednesday. Thanks to yearly screenings with Bevers, Camp will access early treatment, greatly reducing the trauma involved in breast cancer diagnosis.
"Mammograms are a life saving test, and it's a lot less expensive to catch it early on," Camp tells CultureMap. Describing yearly mammograms as "definitely necessary," Camp has now facilitated her daughter undergoing annual screening because of the family's history.
Having devoted her professional life to breast cancer research, prevention and diagnosis, the USPSTF recommendations are a great concern to Bevers.
"If these new guidelines are followed, we're going to start to see an erosion in the strides we've made in preventing women from dying of breast cancer," she says.
At a recent radiologist conference, breast imagers presented studies in several communities to determine the frequency of women visiting to receive a mammogram. Sadly, the research shows a decrease of women getting screenings since the task force released its recommendations. "If less women are getting mammograms, the next thing we'll see is more women dying," Bevers says. "We're already going down that slippery slope. We need to get all women going annually beginning at age 40."
The 2009 release of the task force recommendations coincided with the establishment of a health care reform bill, leading skeptics to question whether the suggested decreased screenings was influenced by aims to lower government medical costs.
"I don't believe that's the case at all," Bevers says. "I know it was seen as rationing, but I don't think this had anything to do with it."
Explains the researcher, the task force began its study before the passage of the bill and is set up on a routine update schedule. Still, she maintains that she disagrees with the task force's recommendations.
"I don't think they thought it through."