Task force advises against breast cancer screening for low risk group

Sharon Parrett knows mammograms and ultrasound examinations for breast cancer are not foolproof.

Despite having had both of those tests, her own cancer went undetected for six months. A biopsy confirmed her worst fears, and that led to a mastectomy to remove the tumour, followed by four chemotherapy sessions.

Parrett, 49, is alarmed at the findings of the Canadian Task Force on Preventative Health, which advises doctors to stop systemic testing of women aged 40 to 49 for breast cancer if they are at average risk of getting the disease because it can lead to false-positive diagnosis and unnecessary procedures.

"That's absolutely ridiculous and they must know that," said Parrett.

"We've paid taxes for years and years, we pay into medical plans for years and years and that's why we're paying for it.

"They just don't want to pay the money. We're supposed to be fighting for a cure, not burying people."

The 14-member task force published its report last week in the Canadian Medical Association Journal. The purpose of the task force is to develop guidelines that help primary care providers deliver preventative health care.

"We've found that the balance between benefits and harms is not in favour of screening women aged 40 to 49," said Michael Joffres, a Simon Fraser University health scientist who was part of the task force.

"The task force has found regular screening of this group leads to over-diagnosis of breast cancer, resulting in unnecessarily heightened fear and anxiety. It also leads to unnecessary biopsies, lumpectomies, mastectomies, and other interventions."

The report also recommends doctors not routinely perform clinical breast exams and suggests doctors not advise average-risk women to routinely examine their own breasts to detect the disease.

The task force did recognize the benefits of breast cancer screening outweigh the possible harm to women aged 50 to 74 who are at average risk. It recommends screening for that group every two to three years instead of every two years, which is now the common practice.

"You think it's an older person's disease, and it's not," said Parrett. "At the time, I wasn't aware of any younger women that had breast cancer. More and more often you hear about younger women being diagnosed.

"I went through my treatment with a friend who was 32 years old - 'too young' for a mammogram until she found her lump. She, in fact, has the cancer gene in her family and underwent surgery and chemo along with me. Cancer is not age specific. Surely to God they should know that by now."

Parrett had her first mammogram at age 43 and was told the lump she had found, as well as a second lump, were nothing to worry about.

"I was told they were 95 per cent accurate and they were 100 per cent wrong," said Parrett. "By the time my physician got on it half a year later my lump had grown from the size of the tip of my baby finger to 1.7 centimetres and the second lump was 2.5 centimetres. I was very angry."

Enid Bond was lucky in the fact her cancer was diagnosed soon after she discovered a lump in her breast. She immediately underwent a mastectomy. Based on her own experience and that of other Prince George women, she strongly disagrees with excluding any age group from screening.

"Sometimes it's there and you don't know it's there, not all of these things are so easily felt," said the 59-year-old Bond.

"If we can save one or two people or three or four people, how do you decide who you save? I would want everyone to have a chance to have that screening. Some women get breast cancer and they don't have a family history, and it isn't gender-specific. There are men who get breast cancer."

Stats

The Canadian Breast Cancer Foundation estimated 23,200 women and 180 men in Canada developed breast cancer in 2010 and that 5,300 women and 100 men will die of the disease.

The incidence of the disease increased 20 per cent from 1982 to 2011 but the mortality rate dropped by one-third.

Eighty per cent of newly diagnosed cases of breast cancer were in women over the age of 50 years, and close to 28 per cent were in women aged 70 or older.