PANEL REVIEWS MAJOR ISSUES

The guidelines on breast screening released Monday by the U.S. Preventive Services Task Force were compiled by a 16-member panel of experts in prevention and primary care.

The task force first gathered in 1984 as mandated by the federal Public Health Service.

Members gather three times a year, to discuss various health topics, from abdominal aortic aneurysm to youth violence.

"We look at key topics ... based on independent reviews of the literature that is presented to the task force," said Dr. Kimberly Gregory, director of the Maternal-Fetal Medicine and Women's Health Services Research at Cedars-Sinai Medical Center.

Gregory has participated in the panel for five years.

Federal partners include the Centers for Disease Control and Prevention, Department of Defense, Centers for Medicare and Medicaid Services, Department of Veterans Affairs, the National Institutes of Health and the U.S. Food and Drug Administration, among others.

- Susan Abram

The way Margarita Navar sees it, low-dose amplified X-rays helped her cheat death.

Had she waited until she was 40 to slip her left breast into a mammography machine, the tiny tumors that spelled Stage 2 cancer would have gone unnoticed.

"Had I waited until I was 40 years old, I wouldn't be alive," said Navar, 45.

Because of her experience, she was puzzled by the guidelines released this week by a federal health task force that recommended against a mammogram before 50 or self breast exams at any age. After all, she'd detected the lumps in her breast when she was 33 and insisted on the mammogram that saved her life.

"I never thought it was breast cancer because there's no breast cancer in my family and I come from a big family of women," said Navar, who works as a patient navigator at Northridge Hospital Medical Center.

"I was in no pain. There were no other signs," she said. "But that's why they call it a silent killer."

Navar joined a resounding chorus of outrage among oncologists, radiologists and breast cancer survivors who said the guidelines released by the U.S. Preventive Services Task Force sent prevention efforts and women's health back into the dark ages.

"It's totally outrageous," said Dr. Harold Marks, who specializes in breast surgery and oncology at Northridge Hospital and said he would ignore the guidelines.

"It's almost like devaluating a woman's life between the age of 40 to 50," he said. "It will cost people's lives in that age group."

Revision of findings

The task force previously released recommendations on breast cancer screenings in 2002, saying then that women ages 40 to 49 should undergo a mammogram.

The 16-member task force revised its findings based on evidence that routine mammograms for 40- to 49-year-old patients did more harm than good, said Dr. Kimberly Gregory, director of Maternal-Fetal Medicine and Women's Health Services Research at Cedars-Sinai Medical Center, who sat on the panel.

"Routine screening is associated with increased anxiety, false positives and complications from biopsies," she said.

But Gregory emphasized that a woman should still get a mammogram if she and her physician believe it's in her best interests.

"I don't think it should be a cause for confusion," she said. "If anything, this should be an opportunity for more dialogue."

Kaiser Permanente officials said their guidelines are similar to those released Monday, but they emphasized the decision is between doctor and patient.

"Any woman between age 40 and 49 who requests screening is given a mammogram," according to Kaiser's guidelines.

But both the American Cancer Society and the Los Angeles County chapter for Susan G. Komen for the Cure announced they would continue to recommend annual mammograms and clinical breast examination for all women beginning at age 40.

But what troubles some physicians is how all the attention on these new guidelines will cause confusion. Several reported receiving calls from patients questioning whether they should keep mammography appointments.

"We had a woman call today who we detected and say she doesn't know if she's supposed to come in today," said Dr. Lawrence Bassett, professor of radiology at UCLA's Iris Cantor Center for Breast Imaging.

"In the more than 30 years I've been here, I've seen a lot. I know that when you look at the results carefully, the years of lives saved are much greater for women who are detected in their 40s than women in their 60s."

`Mammogram police'

Still, some physicians say they plan to consider the new recommendations carefully.

"My first reaction is that it probably had some good people behind it making decisions based on good science," said Dr. Roger Peeks, chief medical director at Valley Community Clinic in North Hollywood.

"It raises the questions of why have we been doing what we have been doing all this time."

Yet Peeks said he would not abandon the American Cancer Society's recommendations until more of his peers study the task force's conclusions.

Diagnosed with breast cancer nine years ago at age 35, Encino resident Cindy Lesonsky recognizes the importance of early detection and encourages all her friends and coworkers to be screened.

"I'm the mammogram police," she said. "I realize it's not pleasant and the test is uncomfortable. But I always say, you really do want to know, because then you can do something about it."