Dr. Hamilton on CNN Discussing New Guidelines from ACS for Breast Cancer Screening  – Sarah Cannon

Dr. Hamilton on CNN Discussing New Guidelines from ACS for Breast Cancer Screening – Sarah Cannon


this is CNN breaking news. hello everyone I’m Kate Bolduan and I’m John Berman we have breaking news at this very hour that affects millions and millions of women brand new guidelines for breast cancer screening just released a minute ago. guidelines that are sure to raise new questions and frankly new controversy because they suggest women should start getting mammograms later and less frequently. joining us now is Senior Medical Correspondent Elizabeth Cohen as well as Dr. Erika Hamilton is the Associate Director of the Breast Cancer and Gynecologic Cancer Research Program at the Sarah Cannon Research Institute. Elizabeth first to you with the news so what is the American Cancer Society recommending now? so kate let’s take a look at their specific recommendations. they used to say that women should start getting annual mammograms at the age of 40 now they’re saying don’t start until age 45. they also used to say that women should get doctors exams in other words a doctor manually feeling the breast for lumps and bumps also at around age 40 and now they’re saying no one needs them. they say that these breast exams as well as mammograms in your early 40s they say there’s no scientific evidence that shows that they catch cancer early and save lives. why is less more Elizabeth? it sounds counterintuitive. I know it really is counterintuitive so what the American Cancer Society says is look mammograms are great there’s no question they save lives but they’re not perfect they have a lot of problems they are notorious for false positives especially on younger women whose breast tissue is denser and harder to image and false positives are a big deal. you know they see something on a mammogram they’re not sure about it you have to have a biopsy, you have to have maybe more mammograms that will give you more radiation it’s a big deal and there are women who have said gosh I’ve gotten so many false positives that I’m going to stop mammograms and of course you know nobody wants women to do that. and so that’s the reason that they say that you just don’t need to do them in your early 40s. and all of this is a very big deal kind of to your point so they’re all so that leads me to wonder is there total agreement around this? right there is not agreement at all around this. and one of the big problems is that the studies that the American Cancer Society and others have looked at our of film mammograms and practically nobody does those anymore we use digital mammograms which are way better than film mammograms so some people think all of these recommendations really they don’t make a whole lot of sense. but let’s take a look at the three major groups that make recommendations to women about when to do screening and see what they say. so American Cancer Society now says start regular mammograms at age 40, the American College of Obstetricians and Gynaecologists I’m sorry American Cancer Society says 45, the American College of Obstetricians and Gynecologists says 40, the U.S. Preventive Services Task Force said start at age 50 so I mean I can just imagine that women as well as doctors are going to throw up their hands and say what do we do and then there’s the question will insurance continue to cover mammograms for women in their 40s now that the American Cancer Society has made their change and I think what experts tell me the answer is is talk to your doctor and decide what risks you’re willing to put up with. if you’re willing to put up with you possibly a lot of false positives then maybe you do want one and that’s why and this is important the American Cancer Society says look we’re recommending 45 but if you want to start at 40 feel free we think you should be able to go ahead and do that but we recommend 45. so doctor you know you are about to get a lot of questions from a lot of confused patients who are going to say hey look I thought early detection was the key here now all of a sudden you’re telling me wait five years before doing this and I also assume this does not apply to anyone with a family history correct? I think that is correct and you know I’m a doctor that sees breast cancer patients on a daily basis, and I’ve seen a lot of young women whose lives have been saved by having early mammograms so I’m really concerned about these young women moving forward without this recommendation. I’m concerned about what it projects of how important we feel mammograms are. I think it’s an individual conversation between a woman and her doctor I think we all know that mammograms aren’t perfect but they are the best screening tests we have and as she already touched on digital mammograms are a lot better than our film mammograms used to be. the other thing is that the Cancer Society really used the basis that a screening test has value when it saves lives, and this is certainly true, but I also think picking up cancers earlier where the treatment is easier for patients we can spare patients mastectomies or chemotherapy is very important for the one in eight women that are going to be diagnosed with breast cancer unfortunately. and doctor what are the things that the American Cancer Society is really leaning on here is the big concern and the big problems that can come with false positives and over diagnosis. obviously everything is on balance what’s the risk where are where is the risk worth it here? for you early detection is it worth those the risk of the false positives? I think it is, and I think even from a cost perspective if the insurance company came to me, called me today and said you know should we spend this money fifty dollars for a mammogram I think that that’s money well spent. we have gotten better at treating these breast cancers even when they’re more advanced and incurable which is an excellent thing for breast cancer and for cancer in general but this comes with a great cost both monetarily to the healthcare system in general and also to the patients that have to live with this incurable diagnosis every day. I think it’s not to make light of the fact that some women do have to go back for an unnecessary procedure such as a biopsy but the problem I have is where we associate over diagnosis as being the same as over treatment. we know that there’s some women we over treat but I don’t think not having that information not having the diagnostic information and then being able to make our own decision with that woman about what to do with that information it is worth the cost of possibly not catching these breast cancers early when there is something that needs to be done about them. you can see right here very clearly not total agreement for sure around these new guidelines, but very important nonetheless to be discussing it. Elizabeth Cohen thank you so much for bringing us this breaking news new guidelines coming out from the American Cancer Society and Dr. Hamilton thank you very much. thank you

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