ELLSWORTH — Breast cancer screening guidelines issued last week by a federal task force have raised furor among physicians, women and breast cancer survivors alike.

The U.S. Preventive Services Task Force announcement that it recommends against routine screening mammography in women aged 40 to 49 years is the opposite of what the American Cancer Society has been recommending for years: annual mammograms for all women beginning at age 40.

Reaction to the new guidelines has been mixed among area health care professionals. One local physician says the recommendations make sense.

Dr. Erik Steele, chief medical officer of Eastern Maine Healthcare Systems, said too many biopsies that turn out to be benign are being performed on women ages 40 to 49.

“If you’re a low-risk woman in your 40s you’re probably not going to find cancer,” Steele said.

A low-risk woman is one who is under age 50 and without a sister or mother who had breast cancer.

“Mammograms in low-risk women don’t work as well as we’d hoped to reduce your risk of dying of breast cancer,” Steele said.

Steele’s advice to women everywhere is to take a deep breath, stop worrying and follow your doctor’s recommendation.

“When the dust settles, there will be some review of the recommendations and the study behind it,” Steele said. “In the meantime, I don’t think it changes anything. I would be stunned if any of the insurance companies change what they pay for as a result of these recommendations.”

If there are changes, they will be a long time coming, he said.

The task force also recommends biennial screening mammography for women aged 50 to 74 years instead of annual screening.

The task force states in its recommendations that the harms resulting from screening for breast cancer include psychological harms, such as anxiety, unnecessary imaging tests and biopsies in women without cancer and inconvenience due to false-positive screening results.

People must also consider the harms associated with the treatment of cancer that would not become clinically apparent during a woman’s lifetime, which is called overdiagnosis, as well as unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman’s life, the task force said. Radiation exposure is also a consideration.

False positive mammogram results are more common in women in their 40s and overdiagnosis more common for women in their 50s, the task force said.

Dr. Jeffrey Kugel, who is a radiologist and medical imaging director at Maine Coast Memorial Hospital, said he is “very opposed to this particular study and its implications.”

“They used criteria that are unquantifiable and you can’t quantify anxiety in a patient,” said Kugel.

The task force cites concern about patient exposure to radiation during mammograms, which Kugel says is “overplayed.”

“Incident radiation takes a relatively long time to generate a cancer,” he said.

Kugel said he is also concerned that the women who are already reluctant to undergo mammograms will use the latest recommendations as an excuse to skip or delay them.

Kip DeSerres, who is vice president of health initiatives for Maine for the American Cancer Society, said, “We’re standing by our recommendation that all women get mammograms starting at age 40. We know a certain percentage of women who are diagnosed with breast cancer are going to be women under 50, so it still makes sense to do the screening. We’re not in agreement with the task force.”

“We specifically noted that the overall effectiveness of mammography increases with increasing age,” said Dr. Otis Brawley, the society’s chief medical officer. “But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives. With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them.”

Steele said the task force is a “thoughtful, deliberate group who does extraordinary work. We don’t always like the message.”

This is the same group who said children need to be vaccinated, Steele said.

“They’ve saved, I believe, thousands of lives,” he said.

Another recommendation from the task force, which states medical providers should not teach women to do monthly self breast exams is another point of controversy.

Dr. Benjamin Newman, a physician in Winter Harbor, is urging women to continue their self exams and their exam schedules with their physicians.

Newman says the recommendations are based on economics, not science.

“The scientific bureaucrats in Washington are really not interested in your health, but rather the bottom line,” Newman said. “So ladies, continue to practice self-examinations, and continue to have your doctor examine you just like you have been doing. It really does make a positive difference, and it could save your life.”

Kugel said the study shows the benefit of self exams as low because not everybody is doing it and not everyone is doing the exams correctly.

However, a lot of women do the monthly exam and they find cancers that aren’t found in mammography, said Kugel.

The American Cancer Society does not recommend the monthly exams.

“The position is that it’s a good idea for a woman to have a general awareness of her body,” said DeSerres. “It doesn’t do any harm to do the self exam, but the studies about it found there was really no lifesaving benefits to teaching a particular way to do it in a structured way.”

For more health news, pick up a copy of The Ellsworth American.

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