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F.C. Doctors Weigh In On Mammogram Guidelines

Survey: States Cut Women’s Access to Screenings

gresingerSome states have already started limiting women’s access to mammograms due to a recent U.S. Preventive Services Task Force panel’s findings, it has been reported.

Falls Church Healthcare Drs. Regine Feuer and Thomas Gresinger, in interviews this week, told the News-Press there’s some validity to the task force’s recommendations that the average woman begin biennial screenings at age 50 instead of the current standard of annual mammograms starting at age 40.

Survey: States Cut Women’s Access to Screenings

gresinger

Dr. Thomas Gresinger, MD of Falls Church Healthcare Center. (Photo: News-Press)

Some states have already started limiting women’s access to mammograms due to a recent U.S. Preventive Services Task Force panel’s findings, it has been reported.

Falls Church Healthcare Drs. Regine Feuer and Thomas Gresinger, in interviews this week, told the News-Press there’s some validity to the task force’s recommendations that the average woman begin biennial screenings at age 50 instead of the current standard of annual mammograms starting at age 40.

But they both said the decisions should be between a patient and her doctor and not subject to mandated restrictions.

Not so sure about the new guidelines, however, is F.C. School Superintendent Dr. Lois Berlin.

The Preventive Services Task Force (USPSTF) recommended a decrease in mammography frequency and proposed “against the teaching of breast self-examination” last November.

Amidst fears this would discourage insurance companies from covering mammograms, Secretary of Health and Human Services Kathleen Sebelius released a statement that same month, affirming that government policy would not change.

“They do not set federal policy and they don’t determine what services are covered by the federal government,” Sebelius said of the task force experts, who are government-appointed.

Now three months later, the call to change how often a woman is screened for breast cancer has already caused some states to diminish access to screenings for women aged 40 to 49, according to survey results released by the Avon Foundation for Women (AFW) last week.

The AFW press release said, “According to respondents, California, New York, Florida, Illinois and Michigan are among those states that have made changes in their state’s breast cancer screening programs since the USPSTF released its guidelines.”

Feuer called the states’ actions “regrettable” and though she does not feel the panel had any financial or political motivations, “there will unfortunately be insurance companies that jump on the bandwagon to take advantage from a purely financial standpoint.”

Gresinger, however, feels that if a woman wants a mammogram but her insurance changes its coverage due to the guidelines, that she should have to pay out of pocket.

“Granted scientific opinion changes all the time, it’s the best we have and if someone wants to go outside of those guidelines, they’re welcome to, but they’re going to pay for it. The government and the insurance companies shouldn’t have to pay for it any more than a nose job or a tummy tuck,” said Gresinger.

Both doctors do, however, think the USPSTF panel has a legitimate point in regard to mammograms. Feuer said her previous practice was to give patients aged 40 to 50 a mammogram every one to two years, and then annually after that for the rest of their life.

“If you do a test and get a result, you have to act on it. In doing that, it triggered a lot of additional testing and biopsies. I think the panel is probably right that we were overtreating very small, slow-growing cancers,” said Feuer, who’s been practicing medicine for 25 years.

This would often result in invasive surgeries, which biopsied larger sections of breast tissue to ensure the smaller, questionable section of tissue was included.

“Because doctors were biopsing so generously, we ended up doing more harm than actually saving lives. There is a tendency to be aggressive, but when you see a woman with a double mastectomy and you realize you didn’t in fact save her life, it’s crippling,” said Feuer.

Gresinger said he’s long switched to biennial exams, but thinks the new recommendations are reason enough to now officially give his patients one mammogram at age 45, and then, as the panel suggests, begin screening once every two years at age 50.

But F.C. School Superintendent Dr. Berlin isn’t as convinced. She told the News-Press, “As a woman over 50, I have been confident in my doctor’s advice to do annual mammograms. Biennial exams can be risky given the nature of cancer growth. I think women, particularly women who are in stressful positions, owe it to themselves and their families to be screened on an annual basis.”

Berlin worries media coverage of the panel’s recommendations will deter women from doing so.

For women with a family history of breast cancer, Gresinger, like Feuer, said “all bets are off.” They agreed a high-risk female should be receiving annual mammograms by age 40. A woman with a first-degree relative – sister, mother, daughter – who’s had or has breast cancer meets this criteria.

Creative Cauldron Producing Director Laura Hull, 55, of Falls Church is one of those women. Having lost her mother to breast cancer in the 1960s when she was 10 years old, Hull’s had breast exams annually since she was 40.

“I have many friends and acquaintances who are breast cancer survivors simply because the disease was detected early. I can’t help but wonder if my mother would have been included in this lucky circle if she had only been born a few decades later, when regular mammograms were the norm,” said Hull.

She called the new findings an “important issue,” adding that women are “constantly told to follow one regimen only to find that there is a new study that tells you to abandon that regimen.”

Echoing Hull’s sentiment, Feuer said insurance companies that limit patients’ reimbursements of mammograms are unfortunate because “what will happen – and I’m sure of it – is we’re going to see an increase in deaths due to breast cancer and the pendulum is going to swing the other way in another ten years.”

She believes there will then be a conclusion of the impact of the panel’s recommendations, and “it may not be a good one for women.”

Gresinger remains an advocate of baseline mammograms for women as young as age 35, so that in the event she does find a lump and a mammogram needs to be performed, there is a comparative record already on file.

F.C. Chamber of Commerce Executive Director Sally Cole credits a baseline mammogram for one of the reasons her friend beat breast cancer. The friend was in her early 40s when she discovered a lump 10 years ago while doing a self-exam and was quickly diagnosed.

“Without the self-exam and a baseline mammogram, her cancer might not have been detected in time. For that reason, and because my doctor informed me that the report had not altered his advice, even though I am in my 40s and have no family history of breast cancer, I will continue to have regular exams and mammograms,” said Cole.

Feuer sympathized with women in this position, saying “If a patient says, ‘Oh my gosh, my girlfriend was just diagnosed with breast cancer thanks to a mammogram,’ how can you convince her not to have one? A woman is never out of line to want a mammogram.”

On the other hand, Feuer and Gresinger were up in arms about the notion women be discouraged from doing monthly self exams. Specifically, the panel gave this a D-grade reasoning, meaning “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”

“The idea of discouraging self-breast examinations – that’s crazy,” said Gresinger.

Feuer agreed, calling the recommendation “counterintuitive.”

“I don’t see the virtue of telling a patient not to examine her breasts,” she said. Many of Feuer’s patients in the past discovered a lump through a self exam. She and Gresinger urged women to perform a monthly self-breast exam immediately following their menstrual cycle.

“That’s when the level of hormones is at its lowest and, therefore, there will be fewer hormonal, lumpy stuff in the breasts to throw a woman off the path,” said Gresinger.

Feuer, who will continue to teach all of her patients how to examine themselves, tells women they are “going to feel those soft, doughy lumps which move around,” but if that a woman “feels something hard like a chickpea that is fixed and does not move, to run to [her doctor].”

Dispelling the panel’s argument that the stress a self exam causes outweighs its benefits, Feuer said that once a woman examines herself three months in a row, she won’t freak out and that it is up to doctors to teach their female patients what to expect and how to accurately perform a self exam.

“A self exam is not aggressive or invasive – it’s a woman knowing her body.”

 

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