Cancer Series: Screening and accuracy of results
December 15, 2011 4:22 p.m.
Dr. Georgia Sadler, Associate Director for Community Outreach, UC San Diego Moores Cancer Center
Peggy Pico, KPBS Science and Technology Reporter
Related Story: Cancer Series: Cancer Screening And Accuracy
CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. The issue of cancer screening at what age to start, how often, and the accuracy of the screening results has become not just a medical issue. There's a lot of politics and money that tag along with the guidelines on mammograms and other cancer screenings. Lately some of those guidelines have been confusing, and ultimately the issue could not be more serious. It can literally be a matter of life or death. As part of her continuing series on cancer, KPBS science and technology reporter, Peggy Pico, is here. She's been sharing her expertise and personal story about breast cancer surgery and recovery. Peggy, welcome back.
PICO: It's good to be back.
CAVANAUGH: And doctor Georgia Sadler is also here of the she's associate director for community outreach with UC San Diego's Moors cancer center. Welcome to the show
SADLER: Thank you very much
CAVANAUGH: We invite our listeners if you'd like to join in, please do call. 1-888-895-5727. How was your cancer detected, Peggy?
PICO: My cancer was originally detected to a mammogram. I requested it myself. I don't know why. They found a small spot. Questionable. It was questionable. So ultimately, we did another mammogram, then an ultrasound, and television the MRI that ultimately picked up the tumor.
CAVANAUGH: So no one actually advised you to have a mammogram? It was something you wanted to do yourself?
PICO: Right. I had had one a few years benefit, and just thought it was time to do it again. And I asked my physician, and she said, sure, go ahead. You can imagine my surprise was because there was no family history, and I didn't think I was at risk
CAVANAUGH: Doctor Sadler, what were the guidelines for breast cancer screening before and how have they changed?
SADLER: They've changed considerably over the years based on the evident that our scientists have been able to produce looking at large populations and diverse populations, really from around the world. Initially, we thought, for example, that self-breast exam was a very good way to found cancer early enough to make a difference in survival rates. Of the data showed it didn't make that much difference. So we no longer recommend that women do self-breast exam. If you'd like to, no one will say don't do it. But we're not spending a lot of time educating the public to do this and how to do this. Then the guidelines were also saying that beginning at age 40, approximately every two years, a woman should have a mammogram. And at age 50, every year a woman should have a mammogram. The public as we change she's guidelines gets frustrated, understandably. I've just learned the guidelines, and now you're changing them. But the public, including the people like me who educate the public, we need to appreciate the changing guidelines are a reflect of evidence. Evidence that says what we thought worked, based on the data we had, we don't think that was quite right. Let's tweak this a little bit and get it better. So the new guidelines are now saying between age 40 and 50, we're not really sure. We can't prove that mam graphic screening makes a different in survival. It doesn't mean you won't find the cancer earlier, but does it really make a difference in how many women live to the ripe old age they're supposed to?
CAVANAUGH: Can you explain that for us? I think the public thinks the minute you find cancer; people are at risk of dying. What you're saying is cancers found between the ages of 40 and 50 don't impact survival rates as much as cancers found after the age 50?
SADLER: It's a little more complicated than that. A cancer found between age 40 and 50 may be a slightly different cancer than a cancer found age 50 and beyond. There's the menopause that women experience that changes the way our bodies function. And that may influence how cancer progresses. So in the earliest consensus panel that our government was holding, it looked like between age 40 and 50, mammography screening didn't make a difference. Then more data came in, are and then it began to be maybe if does make a difference. It just takes longer to see the difference. More years. So from 50 on, you see an improvement in survival rates within seven years. Will earlier, it looked like it was taking maybe 15 years to show an improvement in how the survival curve looked. And now with more data, larger populations, more consistency of how the mammograms were being done -- because remember, we're comparing data from many different countries with many different complexities of population to try and come up with guidelines. Today, the newest guidelines are saying -- we looked at the data again, and between 40 and 50, we'd like to leave it up to the woman to decide what she wants. In all good conscience, we can't tell you it will make a difference.
CAVANAUGH: Peggy, what's your take on that?
PICO: A little different, obviously very personal because I am just a little bit over 40. And I feel because I had stage three, and it was invasive, had I waited to age 50, I would be not successful in recovering. So my personal take on it is, where do you draw the line? If you're telling people age 40 to 50, well, it's up to you and you decide not to, and you do have cancer and it progresses rapidly, then by the time, 50, you get the mammogram, your chance of survival it seems to me, if it's spread, would be less. Very personal, as I said. I can't go against the recommendations. But I'm, like, how many people like me will fall through the cracks? Certainly there's false positives. But what if you don't go and you it die? What's the balance there between a false positive and death?
CAVANAUGH: And what are the negative aspects of having a false positive diagnose? I know that's part of revising these guidelines. What impact does that have on a woman or some other woman or a man who has had a cancer screening and they get a false positive?
SADLER: Let's explain first what is a false positive. False positive means that we thought you had cancer, we proceeded with all the diagnostic workoccupy, and discover that oh, it wasn't cancer to start with. That's still a very good outcome if you're the patient. And we say, gosh, it looked suspicious, but it wasn't anything. That's a false positive. And the woman in the end comes out with no cancer. In the course of doing that diagnostic workup, you have a lot of stress for the woman and her loved ones, you have a lot of expense. You may do some procedures that leave scars on the breasts, a series of biopsies, trying to find the cancer that you think is there, then every year thereafter you have a lot of anxiety for the woman every time she has to go in for a mammogram, it becomes a major reminder of what she's been through. And there's the expense of false positives. In that age range of 40 to 50, cancer is just not that common. It does happen. Our colleague right here is living proof it happens. But it is not that common. And so for me as a public health educator, my biggest concern is we're confusing the women first and over, where we know what to tell them. There's never been any question from age 50 onward, a woman should have a mammogram on a regular basis at least once every 1 to 2 years. And the guidelines vary, once a year, or once every two years. But there's never been any discussion that we should change those guidelines.
CAVANAUGH: I'm just wondering, hearing Peggy's very personal take on this, doctor Sadler, what do you say to women who come to you and say I would have had a very negative outcome if I had waited on my own discretion until I was 50? It must be very difficult to answer that, because what you're doing is you're going by these guidelines, which go along the lines of a huge statistical standard. Many, are many, many women. But when you encounter 1 woman, what do you say?
SADLER: A study of one person is not what you base your national guidelines on. You have to look at the entire population. But what I do tell women in that younger age group, 35 even, you know your body. If you see a change, take a shower, and look at yourself in the mirror. If you see a change, if you feel a change, for heaven sakes, don't wait until the guidelines kick in. You may be the exception. And Peggy didn't have any warning signs. She just decided I think I'll have it done. For her, it was the right decision. She may have had a subconscious sense, I'm changing, there's something different. But the most important thing is, if a woman in the 35 to first year-old, or the 25 to 50-year-old age group discovers an abnormal change, we know our bodies. And if we don't, we should be paying more attention to them. If you find an abnormal change, call your doctor. It's simple.
CAVANAUGH: As a director of community outreach, this may be for galling for you, the idea that -- you say that the idea that the guidelines change is actually a positive thing. But in order to get people, women, to get screened, it must be challenging for you when people don't know whether or not they should go in.
SADLER: Right. But the public health message has to be repeated, and you're helping us today. Of the message is, and there's no question, starting at age 50, every single woman in this town and this country, unless they have some other terminal disease, should have a mammogram. At least once every two years. There's no debate. And so what I would ask our community to do is to do a little more about learning about what the guidelines are and staying on top of them, because they could change tomorrow. We may have a new study that comes in that suddenly answers all of our questions in the younger women. But right now, we don't. So first learn and keep listening. The second thing is to talk about what you're learning to other women because if you are a woman who has a language barrier in her community you may be the only person that can translate the new findings to the 25 women in your church who don't speak English as your primary language. Understand the guidelines and tell women simply what you need to do. California is blessed with both a free diagnostic program for low income women, and a free treatment program for low-income women. You can call your American cancer society and find out which of the programs are taking part in that screening and treatment program. The AAmerican cancer society is there to serve us with that kind of information. And encourage people to change and follow healthy guidelines, being screened, when they should be screened, but also encouraging colleagues who do have the misfortunate of developing cancer, being there to support there. Peggy and I were just talking before the program how important it was for her to call the ACS and get some support from them
CAVANAUGH: I want to also -- I mentioned men a little while ago. Isn't there a changing guideline for prostate cancer screening as well?
SADLER: Yes, there is. And again, it's based on solid, rigorous scientific research. And that's what we have to keep remembering. It's not someone saying well, let's change the guidelines. And it's not a money issue. Because if we can find cancer early, it saves money. If we wait until women are in the terminal stages of disease, it's very expensive, and they will never return to the work force. They will die if we really wait till the last minute. So early detection is a good -- monetary, it's a good, bottom line business decision. Of when we have a good mechanism. For rectal cancer, for example, we know that we can find changes in the colon before they even become cancer. Remove them, and that person will go on to have a normal life. So where you have a good diagnostic, skin cancer, the same way. We can find it early and treat it before it spreads, particularly for malignant melanoma. We can find a melanoma, identify it, remove it before it grows down more deeply into the skin. And that patient will be cured
CAVANAUGH: Peggy, you've heard all this, you've heard doctor Sadler talk about how the guidelines are based and so forth. Do you have any argument to counter this or is it totally your personal experience? And do you feel comfortable advising other women?
PICO: What I would say about it is is this. It's a little of both. As you know, I was registered nurse before
CAVANAUGH: Sure, yeah.
PICO: And so I have that background as well. And on the research I read as a journalist. My -- the clear message, yes, after age 50, do every screening that is recommended. Follow the recommended guidelines. Absolutely. If you're a man right now, that's changing with PSA. Test for prostate Kaneser, collo-rectal cancer, do all the screening ass. The personal side of it, what I would tell people in their living room would be, basically if you have any thoughts, issues, if you think you're at risk, ask. That's what I did. I asked. I said I want a mammogram. Insurance companies have to pay for it if you ask. So if in doubt, you can ask. My personal take on it is I'm willing to risque false positive, I'm willing to go through that for the chance of -- say they say, oh, boy were we wrong! You didn't have it! OKAY, I'm mad, out a little money. But rather than missing it. So I guess my bottom line answer would be follow the guideline, but if in doubt, and you're younger than those guidelines say, go ask your doctor for it. I doubt you're going to find a doctor who's going to say no to you if you say I want a mammogram
CAVANAUGH: I think you're both in agreement on that.
CAVANAUGH: Peggy, what's next for you?
PICO: I'm doing good. My hair is growing back. Actually, there's quite a bit of follow-up. So I will be for the next five years on a medication that's sort of an antibreast cancer medication. I will be going in for more mammograms. Even though I had a mas etc. Me. And familiar up for quite a bit of follow-up for the next five to ten years. So this is an ongoing recovery process. I'm right at the beginning. But it's right to be back at work. It's great to be talking about it and sharing my experiences. And I'm happy to talk to anybody about it.
CAVANAUGH: And this is part of what you described in one of our previous segments as the new normal.
PICO: Yes, are the new normal is very different for me now. And I think for cancer patients, that changed, your perspective on life has changed and your priorities have changed. And my dedication to my health has changed. Although, I did have cookies at the exchange party last night. That's going to change though! Because I'm going to eat healthy.
CAVANAUGH: I want to thank you so much. I've been speaking with doctor Georgia Sadler, associate director for community outreach at UC San Diego Moors cancer center, and of course KPBS science and technology reporter, Peggy Pico. Thank you both so much.
PICO: Thank you
SADLER: You're welcome.