Ray Anne Evans is living proof of the value of mammograms.
At age 41, a routine mammogram discovered a problem in her breast that turned out to be breast cancer.
After a mastectomy, reconstructive surgery, chemotherapy and the drug Tamoxifen, Evans is cancer free, but she still wonders: "What would have happened if I had not been diagnosed at age 41?”
A government task force issued new recommendations this week that women 40 to 49 years old not be given routine mammograms. Evans worries about what would have happened to her if she hadn't had a mammogram when she did.
"Had I waited even a year who knows what would have happened, because it turned out I had two different kinds of breast cancer, so who knows?" she said.
Evans is now a staff member at the Breast Cancer Resource Center, and urges extreme caution in considering the recommendations from the U.S. Preventive Services Task Force.
"I think it's really important to continue with the guidelines as they were written three days ago, before all the hoopla came out -- and that's to have a baseline mammogram at 40 and continue to have your annual mammogram after that.
"It's too important to not know what's going on with your breast," Evans said.
The task force discounted the value of self breast exams and recommended that annual mammograms not be given to women between 40 and 49 years old. It said mammograms among that age population return to many false positives, making the risks outweigh the benefits of early screen.
Dr. Ames Smith, chief of surgery at St. David's Hospital, says he is not changing any of his procedures based on the recommendations.
"There is clear data that shows there is a survival benefit in women that have regular screen mammography between 40 and 50," he said."In my practice, I've seen a number of women in their 40’s who have had very early cancers detected, in some cases, even before they've become invasive cancers.
"It's very similar to picking up a colon cancer before it becomes a cancer by removing a polyp," he says. "In those particular patients, there is no question they are glad those things are detected."
Dr. Smith says he also advocates women do self breast exams in conjunction with regular exams by a physician and possible mammograms.
"The thing that's dangerous about breast cancer is not just the size, but it's its biological potential to spread or metastasize, and by finding these cancers before they're invasive, it means we've found them before they've had an opportunity to metastasize, so that's a huge advantage."
Dr. Smith says he is less resistant to the task force's recommendations that mammograms be given every other year to women older than 50.
"That would be something would be easier for me to go with," he said. "I think that in general, women that are older than 50 tend to have biologically less aggressive tumors."
But he says until there is more research, he will continue to recommend annual mammograms for women 40 and older.
The Susan G. Komen for the Cure foundation, the largest private foundation in the world devoted to fighting breast cancer, is also advising caution when considering the new recommendations.
"Mammograms are the best tool we have for early detection, and right now we should stay the course and wouldn't want to impede any woman from detecting her breast cancer early," says Ramona Magid, executive director of the Austin Komen affiliate.
She says Komen is not changing its recommendations or its funding for annual mammograms.
"Even with today's guidelines, a third of the women who should be screened are not being screened due to lack of access, so Komen will continue to focus on that area," Magid said.
