Breast cancer screening change panned

The same morning a government task force recommended against routine mammography screening before age 50, a 41-year-old woman sat before Kalispell breast surgeon Dr. Melissa Hulvat with a very aggressive form of breast cancer.

“Her tumor was found on a mammogram,” Hulvat said.

Hulvat, co-director of the Bass Breast Center at Kalispell Regional Medical Center, said early detection allowed her patient to find the tumor at a stage where she could offer her lumpectomy as a treatment option.

She said restricting mammography defeats early detection, leading to more mastectomies and chemotherapy.

Hulvat said she, as a scientist, doesn’t rely on anecdotal stories like this one to refute the U.S. Preventive Services Task Force’s finding that most women under 50 don’t need routine mammograms.

“There’s plenty of evidence to support mammograms in women 40 to 50,” she said.

Hulvat pointed out the American Cancer Society and the American Society of Breast Surgeons — specialists on the front line of the cancer battle — strongly oppose the task force recommendation. The surgeon society said that increased use of digital mammography improves survival rates of women between 40 and 50.

“I recognize that mammography isn’t perfect,” Hulvat said. “But it seems foolhardy to throw out the only tool we have. I would support research to find a better screening tool.”

Hulvat said she has seen statistics varying from a life saved per 1,000 screenings down to one per 1,900 screenings. With the perspective of the 41-year-old life saved in her office, Hulvat sees the benefit of screening as far outweighing the risk of anxiety from false alarms and unnecessary biopsies.

“The potential benefit is life-saving,” she said.

According to Hulvat, women shouldn’t worry about the radiation exposure from annual mammograms. She said the level of radiation is not high enough to cause damage.

She said the government task force, part of the U.S. Department of Health & Human Services, is not made up of breast cancer specialists. According to the group’s Web site, the task force is composed of primary care specialists who evaluate the benefits of preventive services.

Along with the new guideline for women under 50, the task force recommended screening every two years for women 50 to 74 and found no value in breast self examination. Evidence was insufficient to judge the value or risk of clinical exams and mammography for women 75 or over.

Hulvat worries that these recommendations in the middle of the health-care debate may affect reimbursements for mammograms down the road. She said that would impact access to care.

“In the back of my mind, I fear that,” Hulvat said.

Doug Wehrli, manager of imaging services at North Valley Hospital, echoed Hulvat’s concerns. He added the American College of Radiologists as another professional group supporting the current breast cancer screening guidelines.

He pointed out the sad irony that the Daily Inter Lake carried the story on the recommendation against screening most women under 50 in the same edition as an obituary for a 44-year-old woman who died of breast cancer.

“As a general rule, we’re finding more tumors at younger ages,” Wehrli said. “That partially has to do with better technology.”

He considers the recommendations a step back to 20 years ago. Wehrli said he has only received a few telephone calls so far from concerned women.

Wehrli said he encourages those who call to continue to follow the American Cancer Society guidelines to receive a baseline screening at 35 to 40 and then annually after 40.

He said that North Valley Hospital offers the latest digital mammography. He, too, said that improving imaging methods makes more sense than cutting screenings because of false alarms and unnecessary biopsies.

According to Wehrli, new technologies include breast tomography, a sort of hybrid of mammography and CT scanning the provides a two-dimensional view or slices for more accurate diagnosis of a suspicious mass. He said MRI screening is also beneficial for breast cancer imaging.

“It’s extremely expensive but it’s a great tool,” he said.

Wehrli said a cutback in mammography screenings from these recommendations would not have a large financial impact on North Valley Hospital.

“You wouldn’t consider it to be a profit center,” he said. “We do it as a service.”

Wehrli said the negative impact would be to women who may choose not to have a mammogram. He said the American Cancer Society just invested many dollars during October to promote breast cancer awareness.

“Early detection really is key,” he said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.