Nov. 27--Dozens of Dallas-area clinics that offer mammograms are largely ignoring new guidelines that could drastically reduce the amount of breast-cancer screening in the U.S.
"As a general rule, almost everybody who knows about this is disregarding the recommendations," said Dr. David Johnston, a radiologist at Solis Women's Health, a clinic at Baylor All Saints Medical Center at Fort Worth.
The guidelines proposed by the U.S. Preventive Services Task Force, if followed strictly, would cut breast-cancer screening nationwide by 50 percent to 60 percent, according to estimates provided by several clinic operators.
The proposed rules stipulate that women in their 40s should forgo annual breast-cancer screening, while women 50 to 74 should be screened every other year instead of annually.
Radiologists who read mammograms said the tests are critical to their patients' health.
"I diagnosed a 40-year-old woman with breast cancer last week. If she had waited 10 years with pre-menopause breast cancer, she would have been dead," said Dr. Tom Johnson, a partner at Prestige Women's Imaging.
The radiology practice runs screening clinics at Methodist Richardson Medical Center and Baylor Medical Center at Carrollton. Johnson, a radiologist for 30 years, said he has specialized in breast screening since 2001.
"I did not anticipate that I would be doing mammograms full time," he said. "It's difficult, and a lot of radiologists don't like to do them. But I find it a challenge."
In the past year, U.S. women had 37 million mammograms, according to the Food and Drug Administration, which monitors the tests. On average, Medicare pays from $90 to $140 for each test. Private insurers reimburse close to those amounts.
"Most insurance companies cover mammograms, but there's been a significant decline in reimbursement for exams that are done outside a hospital setting," said Shawn Farley, a spokesman for the American College of Radiology, which represents the interests of radiologists.
The screenings have grown into a $5 billion-a-year industry nationally since 2002, the year mammograms were advised for women 40 and older.
In Texas, the number of medical facilities that offer mammograms grew from 301 in 2000 to 505 this year, a 68 percent increase, according to the Texas Department of State Health Services, which certifies the facilities.
Dallas County alone has about 50 facilities that provide mammograms. Such businesses could be adversely affected if screening was reduced, several doctors said.
"I wouldn't call it devastating, but it would definitely be hurtful for business," said Johnston, whose clinic handles about 16,000 mammogram screenings a year.
Many radiologists are convinced that the proposed screening changes actually are an effort to reduce the cost of annual breast-cancer tests.
However, the studies that supported the new recommendations, published Nov. 17 in the medical journal Annals of Internal Medicine, make no mention of mammogram costs.
And the studies' researchers insist that their focus was on the effectiveness of screening for cancer in certain age groups.
"The evidence of effectiveness comes first," said Dr. Heidi Nelson, who oversaw the study that brought about the stricter guidelines. "Second is cost."
The task force's findings warned of "psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results."
The studies also mentioned the danger of "unnecessary earlier treatment of breast cancer" when the disease might not have shortened a woman's life.
Last year, 182,460 cases of invasive breast cancer were diagnosed in the U.S., and 40,480 people died of the disease. Though not all women have regular mammograms, a 2005 study estimated that about 68 percent of American women ages 40 to 65 had a mammogram in the previous two years.
"Mammography is not perfect," Farley said. "But we don't think it makes scientific sense to throw out the best test we have because it's not perfect."
So far, the federal government has shown no signs of endorsing any breast-cancer screening changes.
Kathleen Sebelius, secretary of health and human services, said last week that the task force would not be allowed to dictate federal policy on such tests, although it was the same panel that devised the screening standards seven years ago.
Groups that advocate for cancer patients, including the American Cancer Society and Susan G. Komen for the Cure, have criticized any effort to reduce breast-cancer screening.
"We have worked so hard to build public trust and to urge people to get screened," said Komen founder Nancy G. Brinker. "And now they heard that maybe they shouldn't bother. That is dangerous."
Meanwhile, the American College of Radiology announced this week that it would work to exclude the screening recommendations from health care legislation being developed in the Senate.
"This is not a political argument," said James H. Thrall, chairman of the radiology college's board of chancellors. "It is a matter of life and death."
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