The American Cancer Society in October announced new breast cancer screening guidelines for the first time since May of 2003. Almost instantly, TV talking heads and self-proclaimed experts on Twitter went ballistic. CNN went as far as to call the new guidelines, “a move sure to befuddle women.”
Indian River Medical Center and Scully-Welsh Cancer Center surgeon, Dr. Daniel Glotzer, sees it differently.
For starters, he gives women more credit than to believe they’ll be “befuddled” by guideline changes.
Glotzer and the IRMC staff see and treat over 100 cases of invasive breast cancer and almost 70 more cases of non-invasive cancers a year based on the hospital’s 2014 numbers. He knows the big picture of breast cancer firsthand.
Having served both his internship and residency at Manhattan’s Lenox Hill hospital before going on to the famed Memorial Sloan-Kettering Cancer Center and Cornell University’s New York hospital, Glotzer has the facts, the experience and the expertise to accurately assess the new ACS guidelines.
Those guidelines say that for most women, yearly mammograms should begin at age 45 instead of age 40 – hardly a “befuddling” change.
They go on to say that at age 55, most women can switch from annual examinations to having them every other year.
Speaking in measured tones, Glotzer points out, “The United States Preventive Health Task Force came out about two years ago saying the starting age for screening should be age 50. Basically the new American Cancer Society guidelines are just getting closer to what the Task Force’s surveys are already saying.”
That said, Glotzer points out that whether they come from the ACS, the Task Force or the American Society of Breast Surgeons, guidelines are just that – informed recommendations, not ironclad rules.
Nothing the ACS has suggested would prohibit women from starting annual breast cancer screenings earlier or continuing them longer if they so wish.
Women with the BRCA 1 or BRCA 2 gene, for example, which can indicate an inherited susceptibility to cancer, or those with a strong family history of breast or ovarian cancer, might be advised to start screening earlier than age 45 and continue annual exams past 55.
For the vast majority of women in the 40 to 45 age group, however, the ACS believes annual screenings can be an unnecessary emotional roller coaster.
The chances of false positive results, says the ACS, are especially high for women under 45. Younger women tend to have denser breast tissue making tumor detection far more difficult and can often lead to extreme stress for patients called back for follow-up exams. Many think the call back means they have breast cancer. In most cases, they don’t.
“When we start at 40,” says Glotzer, “we’re having a significant number of people who are having extra testing they don’t need. Now instead of trying to put all these people into one box, we’re trying to screen the people who need mammograms the most and screen them in a more comprehensive way.”
When cancer is detected in women in their early 40s, says the American Society of Clinical Oncology, the most common type is “ductal carcinoma in situ” or DCIS. This is a noninvasive cancer, meaning that, “the cancer cells have only been found in ducts of the breast and the cancer has not spread past the layer of tissue where it began.” The current standard for dealing with DCIS is known as a “lumpectomy” or “breast-conserving” procedure followed by radiation treatments.
Glotzer is clearly a fan of this procedure. “No woman today,” he states flatly, “should feel that she should have to give up her breast to live longer.”
The professorial surgeon, whose wife is a breast cancer survivor, can’t resist a quick history lesson. He points out that early in 20th century, when any breast cancer was detected or even suspected, “You had to do a radical mastectomy. It was a barbaric procedure.”
In the 1950s, Glotzer continues, the gold standard was a “modified” radical mastectomy. It wasn’t until the 1970s that breast-conserving lumpectomies became the go-to approach.
Still, just because the ACS screening guidelines have changed – and Glotzer predicts they will continue to do so – screening is still critically important.
In this regard, Glotzer says no one should let a lack of financial resources prevent them from being screened.
He points to the Indian River Medical Society’s We Care program, a cooperative effort with the Indian River County Health Department and 120 area physicians. We Care’s mission is to help provide free medical treatments, including mammograms, to county residents who are unable to afford them otherwise.
Glotzer also can’t resist trumpeting some new developments at IRMC and Scully-Welsh including the introduction of, “accelerated partial growth radiation” or “Mammocite” treatments.
“We’re condensing the five-to-seven weeks of radiation therapy patients typically get with a lumpectomy into just a few days,” says Glotzer. “We now have that available here in our community.”
The IRMC/Scully-Welsh cancer program is now accredited by the American College of Surgeon’s Commission on Cancer.
In any event, now that October – with its ubiquitous pink ribbons and gaudy pink license plate holders at local car dealers – is behind us, it’s time to calmly consider what the new ACS guidelines mean for you and for the ones you love.
Dr. Daniel Glotzer is at 1040 37th Place, Suite 201 in Vero Beach. The phone number is 772-563-4741. The “We Care” program can be reached at 772-562-0123.
