Women's Wellness: Experts Comment on Health Screenings

SIOUX FALLS (Jan. 1, 2010) - Confused about new recommendations concerning health screenings for women? You're not alone! Experts on women's health at Avera weigh in on which recommendations to follow in the best interest of your health.

Mammograms: Annual after age 40 is best
Avera cancer experts Dr. Josie Alpers and Dr. Amy Krie say women should stand by current recommendations set by the American Cancer Society and the American College of Radiologists to have screening mammograms annually beginning at age 40. Screening for women at high risk should begin even earlier. Women of all ages should also do monthly self-breast exams, and get clinical breast exams each year as part of a well-woman checkup.

In contrast, the U.S. Prevention Services Task Force recently issued recommendations that screening mammography begin at age 50, and then take place every two years until age 74. The panel stated that screening women in their 40s can trigger unnecessary further testing, creating extreme anxiety in women. The panel recommended against teaching breast self-examination to women, because the lumps they feel are usually not cancerous, causing unnecessary testing and anxiety. In addition, the panel said there isn't sufficient data to recommend either for or against annual clinical breast exams.

Drs. Alpers and Krie say these recommendations are based on old data, and were made by health professionals who are not involved in direct patient care to women. These recommendations potentially leave women age 49 and younger with absolutely no screening for breast cancer, especially if they don't do self-breast exams or have clinical breast exams, said Dr. Alpers, who is a board certified radiologist and director of mammography at Avera McKennan.

Women in their 40s have a 1 to 69 chance of getting breast cancer, compared to a 1 in 8 chance of getting breast cancer over their lifetime. Dr. Alpers said 17 percent of breast cancer deaths happen in the 40s, compared to 22 percent of breast cancer deaths that happen in the 50s. But Drs. Alpers and Krie agreed that women need to be protected from breast cancer, whether they are in their 40s, 50s, 60s, or older.
 
If breast cancer starts in the 40s, but is not detected until age 50, "there can be quite a bit of growth in that timeframe," said Dr. Krie, oncologist with Avera Medical Oncology & Hematology with a special interest in breast cancer. There can also be significant growth in two years for women age 50 and older.

"We know that mammography is not perfect - that it doesn't catch every case of breast cancer, and that something might show up on mammography that is not cancerous. But if we can save one life, it's a big benefit," Dr. Krie said. It's important for women to realize that in the vast majority of cases, getting called back for another mammogram or breast ultrasound does not indicate cancer. "We strive for as few call-backs as possible, but we are out to find every case of breast cancer that we can. If they are called back for further testing, women should go on the assumption that it is not cancer, but still follow through," Dr. Alpers said.

In order to get the best and most comfortable mammogram possible, women in their 40s should schedule their mammogram the week after their period, Dr. Alpers said.Self-breast exams and clinical breast exams are still vitally important for women of all ages. While most lumps that can be felt are not cancerous, if a lump did happen to be cancer, ignoring it could cost a woman her life.

Saving lives is the primary goal of breast cancer screenings, but also to save a woman from more intensive treatment. Mammography allows doctors to find breast cancer at much earlier stages, when a woman might not have to undergo a full mastectomy, or have chemotherapy. "Day to day, we see that mammography is making a difference, and is saving lives," Dr. Krie said.

Pap smear frequency depends on age, lifestyle
Although recommendations have changed for how frequently women should have pap smear screenings for cervical cancer, an annual well woman checkup is as important as ever, said Dr. Brenda Kallemeyn, OB/GYN specialist with Avera Women's.

The American College of Obstetricians/Gynecologists has changed pap smear guidelines for young women, delaying the first pap smear to age 21, and recommending pap tests every two years instead of every year for women age 21-30. "Studies show that cervical cancer is very slow growing. The risk that a young woman under age 21 would have any cervical changes that would lead to cancer is very small, almost negligible," she said. In addition, because cervical cancer is slow growing and preceded by cervical changes, a pap smear every two years is sufficient. Women with certain risk factors, or those who have had abnormal pap smears in the past, should continue to be screened annually.

Women over age 30 who have always had normal pap smears need to be screened every three years, unless they have a change in lifestyle from being monogamous to becoming sexually active with more than one partner or a new partner.

Yet women should not bypass their annual exam just because pap smear recommendations have changed. "The pap smear is only a small part of a well woman checkup," Dr. Kallemeyn said. An annual exam also includes viewing the cervix to check for any abnormalities, a check of the ovaries for possible growths or cysts, a breast exam, a check of vital signs, a skin cancer check and a general health assessment. "In the best interest of their health and wellness, it's important for women to schedule an annual exam, and get screening tests as their physician recommends," Dr. Kallemeyn said.