Military officials to stand by women’s testing guidelines
Stars and Stripes November 27, 2009
LANDSTUHL, Germany — Military medical officials say they will stick with their current guidelines for Pap smears and mammograms despite recent recommendations by physicians groups that women delay or reduce the frequency of tests for breast and cervical cancers.
Last week, a government task force announced that women should get their first mammogram at 50 and every two years afterward. But Dr. (Lt. Col.) Charles Tujo, head of radiology at Landstuhl Regional Medical Center, said the hospital will uphold the long-standing position of the American Cancer Society that women receive mammograms annually starting at age 40.
Younger women are more susceptible to aggressive forms of breast cancer, which means not getting a mammogram is risky, Tujo said.
"The older a woman gets, the less aggressive the cancer," Tujo said. "So, while we want to pick up all cancers, I’m more concerned about that 42-year-old to get her cancer because that’s the one that might kill her."
In an unrelated report, the American College of Obstetricians and Gynecologists changed its position that women should have a Pap smear annually, recommending instead that the tests be given every two years for women in their 20s.
The change won’t affect U.S. troops, and family members are instructed to heed the recommendations of their gynecologists, who already offer Pap smears to young patients biannually and every three years for women in their 30s, Col. Richard B. Jackson, chief of obstetrics and gynecology at Landstuhl Regional Medical Center in Germany, said in an e-mail.
The mammogram debate was sparked by the U.S. Preventive Services Task Force, an independent panel of doctors and researchers appointed by the federal Department of Health and Human Services. The group concluded that early and frequent screenings often lead to false alarms and unneeded biopsies, without substantially improving women’s odds of survival, The Associated Press reported last week.
"It’s the feeling at LRMC and myself," Tujo said, "that spending the additional money to begin [mammogram] screening at 40 is worth it."
Tujo and his colleagues routinely consult with female patients before recommending biopsies, explaining the risks, such as trauma to the breast and possible infection.
"It’s a collective decision," he said, "and yes, we’re going to do biopsies that turn out to be benign, but to find the early cancer, the small cancers, you are going to have to do some benign biopsies."
The reason for the false positives is that it’s difficult to discern whether a mass — often a millimeter or smaller — is benign or cancerous, he said.
The latest controversy about mammograms is just another round in what has been an ongoing debate and is likely to continue as other organizations, such as the American Cancer Society and the American College of Radiology, weigh in with their own studies.
"We specifically noted that the overall effectiveness of mammography increases with increasing age," the American Cancer Society’s chief medical officer, Dr. Otis Brawley, said in a statement countering the task force’s recommendations. "But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives."
Tujo said women worried about whether they should have a mammogram should consult their primary care physician, or use Landstuhl’s self-referral program, which allows women older than 40 to schedule mammograms at the hospital.
"We’ve seen the great things that mammography can do to find the small cancers," he said.