Mammogram guidelines: How the confusion is impacting your doctor

A combination of strategy and guessing is part of any game. When it comes to spotting breast cancer, Dr. Kristine Hatcher compares the mammogram process to a game of Battleship.

“You have to have two coordinates in order to find a spot inside the breast,” she said.

Hatcher flipped between photos, zoomed in through white-color tissue, and located a spot that they will look into further on a patient’s mammogram at the South Bend Clinic.

“We start with images back to back,” said Dr. Thatcher. “We like to look at them and compare left to right.”

Just like in Battleship, the goal is to use every mechanism possible, to get a potential hit.

For Jennifer Zarembka from South Bend, she remembered the moment doctor’s found a “hit” inside her mother’s breast. Zarembka, who has skipped mammograms occasionally in the past, said she won’t anymore.

“It wasn’t hereditary in her family, so her just getting that out of the blue like that,” Zarembka said. “We are keeping an eye on it now.”

Zarembka let WSBT 22 come into the mammography room with her at the South Bend Clinic. The 43-year-old said she doesn’t pay too much attention to the changing mammogram guidelines, but would rather be safe than sorry, after she saw what happened to her mom.

“She blew it off and thought it was just an infection,” said Zarembka. “And it wasn’t. She waited too long and that was part of it.”

It’s no surprise that many women may find the guidelines confusing. Three different organizations have contrasting recommendations.

Most recently, the American College of Obstetricians and Gynecologists recommend women begin receiving mammograms at age 40, and every year after that.

The American Cancer Society recommends women receive annual mammograms from 45-55 and every two years after that.

The US Preventative Services Task Force recommends women 50 to 74 receive mammograms every two years. They suggest women in their 40s get them based on their comfort.

Under law, Medicare and private insurance plans cover annual mammograms starting at age 40.

But with a new president, and uncertainty with Obamacare as it stands, there may be new questions about coverage in the future.

‘An extra conversation I have to have’

Confusion on when to begin having mammograms and with what frequency, are common questions in Dr. Mark Meekhof’s exam room. He’s been a gynecologist for 23 years at the South Bend Clinic.

In the past 2-3 years, Meehkof has answered more and more questions pertaining to mammograms. He said questions arose especially after Obamacare was instituted.

He said people began looking at the amount of mammograms from a “national cost-effective way.”

“They’re looking at that recommendation as a cost-effective way because of the number of biopsies that may be done that could be considered unnecessary,” said Dr. Meekhof. “When you find something…on a mammogram and you then have to do a biopsy, and it turns out it’s benign.”

Meekhof continues recommending women starting at age 40 receive an annual mammogram; earlier for those who have family members who have had cancers in the past.

“Right now, it’s still our best tool to diagnose breast cancer and find breast cancer at an early stage,” said Meekhof.

But new research continues to call into question if mammograms are the best screening option. A study out of Dartmouth Medical School claims mammograms are more likely to turn up non-life threatening tumors than more serious cancers.

The study calls into question over-diagnosis and over-treatment for potential tumors that may not turn out to be life-threatening.

But Dr. Meekhof remained fixed on his position that mammograms should start at 40: “I don’t want any of my patients to get breast cancer between 40 and 50 because we’re worried about saving money.”

‘It’s something that could have been prevented’

After a patient goes in for a mammogram, Dr. Kristine Hatcher sifts through images to look for any potential red-flags.

Many times, Hatcher said, a tumor isn’t detectable except through image technology.

“The patient doesn’t feel it, the doctor doesn’t feel it, this would be undetected and would continue to grow if we did not find it on mammogram,” said Dr. Thatcher.

For Jennifer Zarembka, this year’s mammogram was a positive one; she told WSBT 22 that the results didn’t show anything abnormal. But she won’t be missing any in the future.

“I kind of get worried about my nieces and my kids,” she said. “We got a lot of women in our family, so they all need to be aware.”

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