Local experts weigh in on mammogram advice

By Courtney D. Clark

Local health experts weighed in this week in response to the federal government’s new recommendations for mammograms.

The U.S. Preventive Services Task Force said Monday most women do not need mammograms in their 40s. It recommends women have their first mammogram at age 50 and get one every two years thereafter.

That challenges the American Cancer Society’s advice that suggests annual mammograms beginning at 40.

Local ob/gyns, surgeons and oncologists shared their views with The Register-Herald.

“I thought the whole recommendation was just crazy,” said Dr. Robert Pulliam at Professional Medical Ultrasonics, a division of Access Health.

“The American Cancer Society’s recommendation of 40 is right on,” he added, “and the secret to finding and treating cancer with success is early diagnosis. Because the only testing used for early diagnosis at the present time is mammography, the new guidelines were really disappointing.”

Dr. Scott Killmer is a general surgeon in Beckley who treats breast cancer. He evaluates breast lumps and abnormal mammograms.

Killmer agreed with Pulliam, calling the recommendation “totally crazy and irresponsible.”

“About 35 percent of the patients I see with breast cancer are in their 40s,” he said, “and about half of them find their cancer from mammograms, in an early state that is well within Stage I.”

“The other half is divided equally, with 25 percent found from self-exams and 25 percent from provider exams.”

Pulliam said he saw a patient Tuesday morning who came in only because she found a lump through a self-breast exam.

“That lump is a breast cancer,” he explained. “Why would people stop self-breast examinations when it doesn’t cost them a dime to do it and can aid in the early diagnosis of breast problems?

“There is no question that a patient with an early diagnosis and treatment will have better long-term results.”

Likewise, Killmer says he has been recommending weekly self-breast examinations to his patients for years.

“Monthly self-exams are just not as adequate,” he explained. “The more a woman examines her own body, the more comfortable and familiar with it she will be. It is exceedingly important to do it more than less.”

The U.S. Preventive Services Task Force influences coverage of Medicare screening tests and many insurance companies as well.

“You have to wonder if this is some backdoor way to limit costs,” said Dr. David Shimm, a radiation oncologist at Raleigh Regional Cancer Center.

“If insurance companies say they are going to stop paying for mammograms before 50, that may affect some women’s mammogram frequency. But assuming the coverage is there, I will continue ordering annual mammograms and begin screening at age 40.”

Shimm says at this point he believes the majority of physicians’ practices will not be changed.

“What you have here is a split decision,” he continued, “which is a lack of consensus among experts.

“I would think if the other major cancer and women’s health organizations follow suit, we would be likely to see a change, but this is one group among a number of groups which have opinions.”

The oncologist added the American Cancer Society, National Cancer Institute and American College of Radiology are also sticking to older guidelines.

“I do not believe this will ever last as a guideline,” Killmer said. “I urge women to continue with the standing ACS recommendations of yearly mammograms, starting at 40.”

Pulliam, who deals with mammography and breast ultrasound, says he hopes the furor on the issue will pass in a few days.

“Then we can go back to where we were,” he said, “and where we should be.”

— E-mail: cclark@register-herald.com