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November 18, 2009

Physician: Take breast cancer report in context

By JESSE DAVIS

Sometimes a little information can be a bad thing.

A recently released set of recommendations regarding mammograms and self breast exams have been misunderstood by much of the media and public, according to Goshen Health System Director of Medical Oncology Dr. Daniel Bruetman. According to the recommendations released by the U.S. Preventative Services Task Force, regular mammograms present no major benefit to most women below the age of 50 and breast self-examinations are largely unhelpful.

Bruetman said these statements have been taken out of context by many who have not read the details of the report. They are not saying no woman should get a mammogram in their 40s or that they should never use a breast self-examination.

“The issue is that the task force basically is updating the recommendations from 2002, and all they’re saying is that based on the scientific evidence available now, mammograms are very useful in preventing death from breast cancer in women, but more significant in women above 50 and 60 than below that age,” Bruetman said. “Even though there is a benefit, it’s not as significant as it was once thought to be.”

He went on to give more detail about both self-examinations and mammograms.

“The self breast exam is not particularly new, and more than one organization has felt that self breast exams don’t really play a major role in early breast cancer detection,” he said. “The role of mammography is to detect lesions we cannot feel. If we’re suggesting that a self breast exam is a good screening test, that is only for something you can feel. It has a different role. It would be unfair if the message was that women should not get mammograms. The recommendation is not to not get mammograms, it’s to put the test in its proper place.”

According to Bruetman, for the general population of women, a discussion with their doctor could determine whether they are in a high-risk group in which they should be getting mammograms in their 40s.

“If you’re not in that group, the benefit is very small,” he said. “Not zero, but very small.”

Part of the reasoning behind limiting mammograms below the age of 50 is due to potential health risks, as small as the anxiety incurred by a false positive and as large as increasing their risk of cancer due to the radiation involved in the test. Bruetman pointed out that biopsies also pose their own risks.

“The main recommendation is that patients and their doctors engage in a discussion as to whether or not this is something they should be doing and what the benefits are that they would get from this test,” Bruetman said.

His main suggestion for people confused by the recommendations — read the report.

“It’s not that hard to read through, and it does give a lot of detail for the rationale for each recommendation, why they’re saying what they’re saying,” Bruetman said. “This is not a blanket statement of black or white, it’s very gray.”

Bruetman is a board-certified medical oncologist and member of the American Society of Clinical Oncology, Indiana Medical Oncology Society and American Medical Association, among other organizations. According to Goshen Health Systems’ Web site, “he is a driving force in the latest in cancer treatment as the principal investigator for multiple clinical trials.”

A copy of the report summary and details are available online at www.ahrq.gov/clinic/uspstf/uspsbrca.htm.



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