TODAY   |  November 17, 2009

Dr. Nancy answers viewers' mammogram questions

Nov. 17: TODAY’s chief medical editor Dr. Nancy Snyderman answers viewer questions about new recommendations for when women should be screened for breast cancer.

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This content comes from Closed Captioning that was broadcast along with this program.

>>> al, thank you. now more on the government's breast cancer screening guidelines recommending that most women wait until 50 to get a mammogram. nbc's chief medical editor, dr. nancy snyderman , is here to answer questions you posed since hearing this report. nancy, a busy day and it will get busier.

>> lots of e-mails.

>> because the response has been huge.

>> right.

>> let's take you through what the new study recommends for mammograms. update people on the news.

>> the new recommendation is for people not at risk, for just routine screening mammography, that that start at the age of 50 and for every other year. the biggest benefit being for women over the age of 60. the seismic change for women 40 to 49 no longer recommended to get routine screening mammography.

>> amid the passionate responses are a lot of women who are concerned because they say that the old guidelines were what saved their lives. for example, we have a woman, peyton, in pennsylvania, who wrote -- "i am a woman diagnosed best cancer at age 45. it was because of me and my self-exam that i found this cancer. it was grade three invasive with three lymph nodes positive. it infurts me that this study is suggesting that self-exams are useless. if i had not done this exam, i would be dead right now." so, what are we saying to women like this one?

>> well, we're saying with great sensitivity, and i understand this, is that there are big bodies of science where we really do look at the numbers across all women and all age groups who begin mammograms and then the antidotes, the personal stories. we all know women who have found their breast cancers or were diagnosed at 28 or a routine screening and found cancer at 40, and those stories matter, but the recommendations are that for every story like that, there may be 1,900 other women who got unnecessary radiation for whom screening wasn't the issue. so, cancer is always personal, but these recommendations are supposed to give us scientific guidelines as to how we screen people from now on.

>> but if, in fact -- let me just go back on that for a little bit. if, in fact, the self-exam shows you that you have a lump and even if the chances are overwhelming that you won't find anything, but there's a chance that you would, what's the hurt? why not just let people self-exam? what's the pain?

>> if you do self-exam and you're comfortable with it, fine. here's the counter to that. a lot of women have been taught to sort of do this search-and-destroy mission on their bodies every month, such that our breasts are our enemies. and the yield is low unless you know how to do a good breast self-examination, and for those women who do find lumps, great. but sometimes we think that all breast cancers are the same. some breast cancers come, may sit for a long time and mean nothing. others like this woman are very aggressive. if you find a lump, absolutely tell your doctor. all we are saying is that for the average woman, the yield is very low.

>> okay. the next question is from cindy in albany, and she writes, "what would determine high risk to start mammograms at age 40?"

>> very good question. strong family history , someone who's already undergone gene testing and you find out that brca1 or brca2 are other risk factors . colorectal prostate cancer in your family. or if you've been on hormone replacement therapy , your risk is higher. but for the average woman who says, ah, i don't have any of that in my family, that's who these new guidelines are intended for.

>> next writer is from new york, deborah, and she says, "do these new guidelines give insurance companies a way out of covering yearly mammograms for women ?"

>> right now, insurance companies have said no, they're not going to change everything, and i think it's because there is this debate with physicians on either side. however, this group is an independent group , does advise government and insurance companies and other bodies, and do i think that this will come up? i would be naive to think that this might not come up. however, this report was not timed to the idea of reimbursement because we're going through health care reform debates. this report came out just because it came out. but i do think of how we pay for what will come to the public, to the surface. now, i've been on record as blasting insurance companies , you know, ten ways to sunday. but here's one thing i think we really do have to ask ourselves. if we're talking about how well we spend money in this country and the yield is low for that 40 to 49-year-old group, would we be better off to take that money and spend it elsewhere, looking for better ways to screen the mammography treatment?

>> do you think that influenced this finding?

>> no, no, no, no. absolutely not.

>> you think only this finding is purely based on science?

>> i looked at who did this. i looked at the organizations -- stanford, georgetown, harvard, m.d. anderson . these are scientists who came together without government pressure and said these are our recommendations.

>> dr. nancy snyderman , you'll be talking about this all day.

>> this has touched off a big, collective nerve in this country. we'll have more tonight.

>> thank you very much for your perspective and awareness on all this.