Mammogram controversy has southern Iowans asking questions

BY CINDY TOOPES, Courier staff writer

OTTUMWA — Jenny Schmidt and Mable Hart are true believers in mammograms. The two breast-cancer survivors argue new mammography guidelines issued by the U.S. Preventive Services Task Force are not only wrong, it may be sending a dangerous message to women.

Schmidt of Agency said she “totally disagrees” with the task force’s findings, which were issued last month. Her self exam did not detect a lump but her annual mammogram did.

“I was lucky. It was early enough — stage one — that I needed only a lumpectomy and not a mastectomy,” she said. “They removed the tumor. If it had gone on, if I had waited or did it every other year, then the cancer would have been at a different stage and I believe the outcome would have been significantly different.”

Fellow breast-cancer survivor Mable Hart of Ottumwa agrees.

Hart said she didn’t find a lump 10 years ago when she was diagnosed. She had a mammogram and the radiologist spotted something that was “probably nothing” but they suggested she see a surgeon.

“And the surgeon said it probably wasn’t anything, but ‘let’s do a biopsy,’” she said. “If radiology hadn’t detected those specks on my mammogram, I could have died. I was in stage three and cancer was in my lymph nodes so I had chemotherapy.”

Mammograms are “so important,” she said.

Medical professionals and area supporters concur; they too aren’t happy with the mammogram guidelines crafted by the task force.

At issue is the task force’s suggestion as to when women should start mammograms, how often they should get them and whether they should also undergo a clinical breast exam.

“[The task force] has extended the age by recommending starting at age 50 and getting one every two years,” said McCreery Cancer Center Director Barbara Bal. “That’s different than before, which was to start at age 40 for an annual mammogram and a clinical breast exam.”

The American Cancer Society College of Surgeons in Radiology recently stated the task force didn’t consider advances in technology — such as digital mammograms and MRIs — and women who have a history of cancer in their families, according to Ball.

“Every cancer center is concurring and recommending American Cancer Society standards should stand,” she said. “We do see women 40 to 50 years old and the mortality rate is reduced.”

Ball also wondered if the task force was “charged with reducing the cost of health care.”

Dr. Jeff Schenck is the director of diagnostic imaging at Ottumwa Regional Health Center and he struggled with the idea of a task force worrying about “how to save a dollar a day” or the idea of telling women ages 40-50 that they don’t need a mammogram.

“What about the woman who’s 41, doesn’t know she has breast cancer, she follows the [task force] recommendations, but meanwhile her cancer is growing?” he said. “In nine years, or waiting until she’s 50, we know what happens — the cancer spreads.”

Doctors could have taken care of a small cancer and periodic testing makes sure it hasn’t spread.

“A mammogram can detect a cancer the size of a mustard seed, which is about 5 millimeters,” Schenck added.

“Our concern is we’re missing people who are waiting another 10 years,” Ball said. “We’re very fortunate to have the Komen Race for the Cure so women with no insurance can be covered for an annual screening. There’s no reason for a woman not to have a mammogram.”

Ball said the cancer center continues to support the ACS recommendation for breast-cancer screening guidelines, which is to use mammography and clinical breast examination for all women beginning at age 40.

Schenck said the hospital’s diagnostic imaging department will also continue to support recommendations by the American College of Radiology and ACS.

The task force recommendations, Schenck insists, “could eliminate the past 20 years of significant improvements made in the fight against breast cancer.”

And, breast-cancer mortality rates have decreased 30 percent since 1990 due to the onset of regular mammography screening, he added.

Shannon Briner is the Komen Race for the Cure co-chairwoman for the 2010 race.

“Breast cancer is the leading cause of death among women 40-49,” she said. “Twelve percent of women run the risk of developing breast cancer in their lifetime and that’s one in eight women.”

In a nine-county area in southeast Iowa, there are about 71,000 women and 12 percent means 8,500 women “will likely face breast cancer and lose.”

Hart even wonders if starting exams at age 40 is soon enough.

“Women in their 20s or 30s can get breast cancer. How can they put an age on it?” she said. “Look at me. I’m not obese, I’m healthy, I exercise and I got [cancer] ... They’re way off base with this age 50 thing.”

Cindy Toopes can be reached at (641) 683-5376 or via e-mail at cindy@ottumwacourier.com.

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