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Updated Sunday, November 22, 2009 12:27 am TWN, By Julie Steenhuysen, Reuters

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Breast guidelines test tolerance

“We are too often assuming benefits that have no basis in fact. Medical care should be guided by good science.”

Guidelines Appear Callous To Some

But some doctors said the new breast cancer guidelines that focus strictly on science and evidence appear callous and unfeeling, especially to American doctors and patients who have trouble overcoming the intuitive belief in repeated screening.

Cynthia Ryan, an English professor at the University of Alabama at Birmingham who studies how breast cancer is portrayed in the media, said such an abrupt change follows years of aggressive communication campaigns.

“Everyone knows someone who has had breast cancer,” said Ryan, who has survived two different breast cancers.

She said the new guidelines feel like a huge step backward to a generation of women who have been told they can save their lives if they do self breast exams and are vigilant about getting yearly mammograms.

“We're emotional because we're so damn confused,” Ryan said.

Dr. Kyle Hogarth, who directs a lung cancer risk clinic at the University of Chicago School of Medicine, said there are no official guidelines for lung cancer screening.

“The argument against screening for lung cancer has been that when you start to order CAT scans on smokers, you find all kinds of nodules. Only a very small percentage will be malignant,” Hogarth said.

He said guidelines need to balance the effectiveness of the screening with the rates of false positives.

“If I told you that you had a nodule on your lungs, are you going to be sleeping well for the next couple of months?”

But only 15 percent of patients with lung cancer survive. When a woman is diagnosed with an early breast cancer, she has a very good chance of survival.

Hogarth said breast cancer is a special case.

“When you have a disease that has a strong advocacy base and you are saying on a surface that the mantra is changing, you can guarantee there is a push-back,” Hogarth said.

“That also factors into guidelines, even though everyone would like to think it doesn't. Politics is everything.”

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