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Robin Coyne, RN, MSN, a family nurse practitioner who works with Dr Bevers, says it would be taking a “step back” to change practice. “We’ve been telling women in their 40s to get a yearly mammogram for years now, and our guideline is still to initiate mammography [at] age 40 because we feel enough data support that practice,” Ms Coyne told Oncology Nurse Advisor. “When women know that it’s been the guideline for a long time, to tell them, ‘No, we’re not going to give you a mammogram’—that’s hard for them to hear.”
These sentiments supporting continued early mammography are echoed by Susan Boolbol, MD, a surgical oncologist at the Beth Israel Medical Center in New York City. “There are many studies showing a survival advantage with early detection [based on routine mammographic screening starting at age 40],” said Dr Boolbol. “If breast cancer is diagnosed at its earliest stage, chemotherapy is not needed. At larger sizes and later stages, chemotherapy frequently is part of the treatment plan. This addition of chemotherapy has an enormous impact on quality of life. Having mammograms every 2 years instead of annually may potentially increase the number of women who will require chemotherapy.”
Mary Cahill, RN, a staff nurse who works with Dr Boolbol, relays this decision to stick to the status quo to the patients treated at the hospital. “We get a lot of women asking us about the new guidelines; they’re very confused because they’re hearing and reading conflicting information,” said Ms Cahill. “We tell them that we have not changed our guidelines because the evidence is not compelling enough to support a change.”
BREAST CANCER-SCREENING CONTROVERSY LIKELY WON’T GO AWAY SOON
The currents that have been stirred up by this debate are too deep and too strong to dissipate overnight. Patients, nurses, and the rest of the nation will continue to watch, wait, and worry about which way the winds will blow—and whether safeguarding a high standard of health care, including prevention, is still possible in the face of growing pressures to be able to balance the budget some time in the decades to come.
“I don’t know what you think your life is worth, but a lot of women are going to say, ‘My life is worth more than 1,900 biopsies,'” says Dr Bevers in summing up the prevalent attitude. So stay tuned… ONA
Rosemary Frei is a medical writer in Toronto, Ontario.
REFERENCES
1. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716-726.
2. Nelson HD, Tyne K, Naik A, et al, for the US Preventive Services Task Force. Screening for breast cancer: an update for the US Preventive Services Task Force. Ann Intern Med. 2009;151(10):727-737.
3. Woolf SH. The 2009 breast cancer screening recommendations of the US Preventive Services Task Force [letter]. JAMA. 2010;303(2):162-163.
4. ACOG Practice Bulletin No. 109: Cervical Cytology Screening. Obstet Gynecol. 2009;114(6):1409-1420.
