Bloomington Herald-Times
November 19, 2009
New mammogram guidelines questioned
Many local women, health professionals still favor starting at 40
By Dann Denny
November 19, 2009
Some local women say they are not going to follow a new federal task force recommendation that women wait until they're 50 to start getting mammograms because the potential harm of getting them earlier than that outweighs the benefits.
For decades, women have been told to get a mammogram every year beginning with their 40th birthday.
"I'm disappointed in the recommendations," said 43-year-old Kim Williams. "I feel women need something in that age bracket (40 to 50) to give us some peace of mind. We all know many friends and relatives who have gone through breast cancer."
At age 35, Williams started having mammograms every other year until age 40, when she began undergoing annual mammograms. "I'll continue to get mammograms every year," she said. "I know women under age 50 whose cancer was caught from mammograms."
The task force experts say mammograms are not very reliable for women in their 40s unless they have a history of breast cancer; and that they needlessly expose women to potentially harmful radiation and produce false positives that create undue worry and prompt unnecessary follow-up testing and biopsies.
They also say women ages 50 to 74 need a mammogram only every two years, not annually as they've been told for years; and they recommend that women forgo the breast self-exam because there is little evidence it can prevent cancer deaths.
Despite the new recommendations, made by the U.S. Preventive Services Task Force and based on commissioned studies, Cynthia Parkes said she will not alter her current regimen of having a mammogram every other year. She said she's not worried about the small amount of radiation she'll be exposed to.
"There are risks to every kind of test," said Parkes, a 45-year-old Bloomington woman. "I feel the possibility of early detection and treatment of breast cancer outweighs the risk of getting too much radiation."
Likewise Jill Bailey, 47, of Bloomington, said she will continue getting annual mammograms, a practice she began at age 40.
"There are too many women who've had breast cancer to not have a mammogram," she said. "Early detection is huge."
Bailey said she's not concerned about the possibility of having a false positive.
"I might be stressed for a day or two, but it would be such a relief to know I didn't have cancer," she said. "I'd much rather go back for a follow-up exam than be completely in the dark."
Controversy brewing
The recommendations by the task force have sparked a national firestorm.
Many breast cancer experts and national advocacy groups have condemned the recommendations; and this week the American Cancer Society, American College of Radiology, and American Society of Breast Surgeons firmly reiterated their stance that women should begin getting annual mammograms at age 40.
"This has caused quite an uproar, and created a lot of confusion," said Dr. Bruce Monson, director of the SIRA Breast Center in Bloomington. "We've gotten a lot of calls. I've had more people ask me about this than any topic in a long time."
Janice Ross, manager of Bloomington Hospital's Olcott Center for Cancer Education, said the center has been flooded with phone calls and e-mails.
"Most of the messages are coming from breast cancer survivors," she said. "They're very concerned that the messages women are getting about mammograms are confusing."
Ross said she's advising woman in their 40s to talk to their physicians about whether or not to get annual mammograms, based on their personal and family history.
"African-American women are at higher risk of developing breast cancer before age 50," Ross said. "Not having a mammogram might be a missed opportunity for early detection in those women."
Monson said he's telling women to keep following the long-standing guidelines established by the American Cancer Society and American College of Radiology.
"I had not heard of this organization (the U.S. Preventive Services Task Force) until yesterday," Monson said. "I don't believe we should suddenly base everything we do on what they have to say."
Monson said the task force did not conduct a clinical study, but drew its conclusions from a computer-generated analysis of previous studies.
Breast cancer is the second-leading cause of cancer deaths among American women, behind lung cancer. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.
The task force admits that 15 percent of breast cancers in women in their 40s are detected through mammograms, but says for every 1,000 women in their 40s screened for breast cancer, there are 2 cancers found and 98 false positives.
"The task force is looking at the population as a whole," Monson said. "But how do you weigh the value of an individual life?"
Monson said of the 286 breast cancers diagnosed at SIRA last year, 9 were in those under 40 and 28 were in those ages 40 to 49. There were 79 cases between ages 50 and 59, 92 between 60 and 69, 51 between 70 and 79, and 27 older than 80.
"The task force recommends that women over 75 not have a mammogram," Monson said. "What they're saying is that women that age are too old to worry about treating, but we find a lot of breast cancer in older ladies that is very treatable and sometimes add years to their lives."
Insurance concerns
Because the task force's recommendations influence coverage of screening tests by Medicare and many insurance companies, some fear that women in their 40s will lose their insurance coverage for routine mammograms.
Others say insurance companies, fearing a Vesuvian backlash from women, will continue providing coverage. A spokesman for Americas Health Insurance Plans, an industry group, said this week that insurance coverage is not likely to change because of the new guidelines.
"I hope insurance companies use some common sense, look at the data from other organizations, and realize that screening women in their 40s saves lives," Monson said. "It's hard not to be skeptical that one of the task force's goals was to save money."
But if coverage is taken away, some women may opt to not have mammograms or have them less frequently.
"Right now my insurance pays for my mammograms," Williams said. "If my insurance stopped paying for them between age 40 and 50, I would probably still get them, but every other year."
False positives
The task force admits that screening plays a role in detecting breast cancer, but it comes with a cost. It says mammograms produce false positives in about 10 percent of cases -- causing anxiety and prompting women to undergo unnecessary follow-up tests or biopsies.
"Mammograms are not perfect and there are false positives," Monson said. "This can cause some anxiety, but you have to compare that to the benefits of finding breast cancer and preventing death."
Breast self-exams
The task force further recommends that women stop doing breast self-exams because there is little evidence they can prevent cancer deaths.
In recent years, medical groups like the American Cancer Society have been backing off the promotion of breast self-exams because of a dearth of data showing they're effective.
But Monson said he still feels the breast self exam and clinical breast exam are worthwhile detection tools.
"I don't have statistics, but anecdotally we have lots of patients every year who find a lump that turns out to be cancer," he said "It's still worth the time and effort to do it."
IU safety group recommends safer crosswalks, bus stops
By Mike Leonard
November 18, 2009, last update: 11/19 @ 1:44 am
Multiple incidents, including three fatalities in the past seven years, has prompted an Indiana University task force to recommend more effective pedestrian crosswalks and an extensive education campaign on the Bloomington campus.
The Bloomington Campus Traffic Safety Task Force report also calls for coordinating the locations of campus and city bus stops, and establishing an IU Bloomington standing committee with ongoing oversight of issues related to campus traffic safety.
Provost and Executive Vice President Karen Hanson created the task force on Sept. 18, charging it to study traffic safety issues, examine factors that had led to recent accidents and recommend measures to improve safety throughout campus.
"The task force has conducted a thorough investigation of the issues and made thoughtful and appropriate recommendations," Hanson said in a prepared statement. "The campus is grateful to the members of this group for their outstanding work, and we look forward to working with the City of Bloomington to improve campus traffic safety for students, staff, faculty and community members."
The task force was chaired by Kurt Zorn, associate vice provost for undergraduate education, and Paul Sullivan, deputy vice president for capital projects and facilities. It included representatives of various IU offices and departments; student, staff and faculty representatives; and members from city government.
"One thing I'd like to underscore is the cooperation the task force got from the city. It was fabulous," Zorn said. "The fact is that the major thoroughfares through campus are city streets -- Fee Lane, Jordan Ave., 10th, Third, Atwater. So we really couldn't get anything done without the city's full involvement. I think (police chief) Mike (Diekhoff) and (public works director) Susie (Johnson) were at every meeting."
Zorn said one clear impediment to improving pedestrian safety is "confusing" language in state statutes regarding crosswalks and pedestrian and vehicular rights and responsibilities. The only thing that is clear, Zorn said, is that vehicles must yield and pedestrians have the right of way at signalized intersections where illuminated "walk" and "wait" signals exist.
After that, he said, "the interpretation that is best enforceable policy is that code doesn't give the pedestrian the right of way in a crosswalk, even if it is marked. "Pedestrians are not supposed to put themselves in danger in front of a vehicle, he said.
Adding to the confusion, Zorn said, is the mix of IU students from many states and countries, where vehicle and pedestrian rights vary. "In California, for example, the law is clear, pedestrians have the right of way, and both pedestrians and drivers know that," Zorn said. In other parts of the country, laws might emphasize the pre-eminence of vehicular rights, and, for example, many cities strictly enforce jaywalking statutes.
Another clear problem is attention to the surroundings, the associate vice provost for undergraduate education said. "You have pedestrians not paying attention to what they're doing. You have bicyclists not following the rules of the road. You have distractions on behalf of the operators of vehicles -- doing everything but paying attention to driving. You have cell phones, the radio, eating something, daydreaming. Putting all of that into the mix increases the possibility of an accident."
The task force met five times during October and compiled reports and recommendations after that. The recommendations include:
Undertaking an extensive safety education program, ensuring that the campus community understands the "rules of the road" and the inherent dangers associated with pedestrian, bicycle and vehicle traffic on campus.
Implementing a plan that creates a new type of pedestrian crosswalk with clear delineation of a "safe zone" in which pedestrians have the right of way. The crosswalks would be installed first at two locations on Fee Lane, with more sites possibly to follow.
Making a limited number of changes in bus stops with the goal of eliminating confusion between IU Campus Bus and Bloomington Transit bus-stop locations.
Engaging a traffic engineer to study pedestrian, bicycle and vehicle traffic patterns with attention to speed limits, traffic signals and street alignment. The study would be coordinated with implementation of the campus master plan.
Forming a standing committee or advisory body to maintain oversight of campus traffic safety issues and coordinate efforts with the City of Bloomington.
Zorn said that of all of the recommendations, education efforts look to have the greatest immediate and long-term benefit. He said the safety message aimed at drivers and pedestrians should be simple, visual and straightforward and it should be displayed and repeated often. The task force suggested enlisting the involvement of the Office of Enrollment Management and Residential Programs and making use of the campus Web page, social networking tools, orientation and student-information meetings, Campus Bus messages and the media.
The task force was organized after a fatal car-pedestrian accident on Sept. 9, which killed Peter Duong, a 19-year-old sophomore from Terre Haute.
The complete report can be seen at online at http://www.iub.edu/provost/traffic/.
