MURRAY, UT (2/19/2010) — Three months after a national panel issued relaxed guidelines for mammography screening and in the midst of a slumping economy, the number of women who have the test for breast cancer is falling in Utah, and cancer specialists fear the result will be thousands of potentially preventable deaths nationwide.
"Some of our hospitals in the Salt Lake Valley have seen a decline of more than 30 percent in mammography screening," says radiologist Brett Parkinson, MD, director of the Breast Care Center at Intermountain Medical Center.
Data show a decline of more than 14 percent in women having mammograms at Intermountain hospitals statewide in January, compared to the same period a year ago. This is especially troubling considering that even before the recent decline, only 64 percent of Utah women were getting recommended mammogram screenings.
"Last year we worked on President's Day because we had such a backlog of women who wanted a mammogram. This year, we took the day off. We have a lot fewer women trying to get in," says Loy Hunt, a mammography technologist at Logan Regional Hospital.
Anecdotal evidence shows that the decline extends far beyond Intermountain facilities in Utah, and even beyond Utah's borders.
"We've also heard from colleagues throughout the valley and in places like New Mexico, Connecticut, and Florida that they're seeing a similar decline," says Dr. Parkinson. "This is very alarming news."
In November, the United States Preventive Services Task Force changed its recommendations for mammography screening, advising women of average risk to wait until age 50 to get their first screening, and then only every two years. It also excluded women older than 75 from regular screenings altogether. Previous recommendations called for tests every one to two years for all women beginning at age 40.
The changes sparked heated controversy, with several groups rejecting the new guidelines. The American Cancer Society, the National Cancer Institute, the American College of Radiology, the American College of Surgeons, the American College of Obstetrics and Gynecology, and the U.S. Secretary of Health and Human Services have all urged women to follow to the old recommendations.
"Today, I think we're seeing the dangerous fallout of this confusion. Women will pay with their lives," says Dr. Parkinson. He says other factors could also be contributing to the declines, including loss of jobs and insurance, and the weak economy.
Nearly 20 percent of breast cancers occur in women age 40 to 50. If these women stop getting screenings this year, there will be an additional 12,000 deaths nationwide due to late diagnosis of breast cancer, says Dr. Parkinson. There will also be more unnecessary deaths for women over the age of 75.
"These estimates are based on the task force’s own statistics,” he says.
Treatment is also likely to be more invasive and aggressive if women wait until they feel a lump to seek treatment. Advanced cases require procedures such as a mastectomy or chemotherapy.
"I know some skeptics will say that hospitals only want women to have mammograms to bring in more dollars. But the reality is that hospitals make more money when women delay diagnosis. Advanced cancer is more expensive to treat than cases caught at an early stage," says Dr. Parkinson.
He continues to advise all his patients that mammography screening should begin at 40 and continue for as long as a woman is healthy enough to endure the treatment for breast cancer. And he reminds women age 50 and older who may not have insurance that they can get a free or reduced-cost mammogram from the state-run Utah Cancer Control Program by calling 1-800-717-1811.
"Women should not see this as an optional procedure. Mammography saves lives. That is the bottom line," he says.