Latinas could be at risk with new mammogram guidelines

Mammogram guidelines are flawed
Baltimore Sun.com, Opinions

I am a physician in practice. I have been reading the new mammogram guidelines from the so-called government panel of experts, and I have been exasperated at the plain old stupidity that marks these guidelines ("New mammogram guidelines fuel contradiction, confusion," Nov. 17). The American Cancer Society recently let it be known that doctors may have been over-treating a lot of early and small breast cancers, causing more harm than good in the process. Their contention is that many of these cancers will actually regress even without treatment and will not reduce the lifespan of afflicted individuals. But the American Cancer Society does not know as yet, and therefore has not clearly defined the characteristics of, the tumors that will regress versus those that will enlarge and spread. In the meantime these guidelines have emerged and caused a legitimate furor.

With regard to mammograms, doctors and patients have to be careful. This team of government experts has even left breast self examination in the dust, an unwise move. Also breast cancer is highly correlated with obesity and diabetes -- two, chronic and rampant conditions, even in premenopausal women, in this country and across the world. It is well known, in the medical community, that with the higher incidence of obesity and diabetes in Hispanic and African-American women, they are even more susceptible to breast cancer than their white counterparts.

African-American women die in greater numbers from breast cancer, being more likely to have the advanced stages of the disease at diagnosis, and having a greater rate of recurrence and spread. Considering the numerous publications about the racial disparities in medicine, now we are supposed to ignore the inherent increased risk in African-Americans and Hispanics for this disease and postpone getting mammograms in this subgroup until age 50 years?

A diet rich in vegetables and fruits and low in red meat, combined with regular exercise, is protective against breast cancer. Most poor and illiterate women who neither exercise nor eat a healthy diet are therefore at a higher risk than their affluent sisters. Then there are yet to be understood and unraveled environmental factors, like pesticides and plastics that may contribute to the incidence of all cancers.

It is very cynical that women above the age of 75 years, by this panel's restrictions, will probably be denied mammograms as unnecessary for that age group. Women of this age group fall prey to breast cancers all the time, and among the baby boomers, there will be many when they hit this age who will be at a higher risk because of previous hormone replacement therapy, promoted relentlessly in the past by the pharmaceutical industry and mainstream medicine. The more you think about it, the larger the risk pool grows and the more idiotic this panel seems.

We must improve our diagnostic tools to reduce radiation exposure and increase accuracy. We must avoid unnecessary invasive procedures that cause profound anxiety in patients. Agreed. But we must stop dithering. Not only women with genetic susceptibility or those with a family history of breast cancer, whether young or old, whether premenopausal or postmenopausal, a lot more women than this panel would admit, are at risk for all cancers and particularly for breast cancer.

What is staggering is the malpractice risk involved for doctors if they were to follow this expert panel's guidelines exactly as spelled out. If this declaration is one of the results of the Obama administration's endorsement of "comparative efficacy" studies, comparing many medical therapies and diagnostic tools for their cost effectiveness and usefulness, I dread to think of what else is in store for the already beleaguered physicians and patients in this country. I see "one size fits all " guidelines beckoning tantalizingly, a boon to the cost cutters and the care deniers of medicine.

Usha Nellore, Bel Air