Nurses voice concern about new guidelines

New guidelines for breast cancer screenings have area nurses concerned.

The U.S. Preventive Services Task Force issued new guidelines on Nov. 16 that recommend women begin mammogram screenings at age 50, not 40 as previously recommended. The new guidelines also suggest that women receive a mammogram every other year instead of every year.

Area nurses and nurse practitioners worry that the new guidelines won’t catch early stage breast cancer in women age 40 to 49.

“The guidelines are based more on numbers versus the value of human life,” said Charlene Wallace, RN, MS, OCN, an oncology nurse at Shawnee Mission Medical Center. “If we let those (cancer cases) go for years the prognosis is going to be worse and there are going to be deaths.”

Wallace said about 20 percent of the cancers diagnosed at Shawnee Mission Medical Center occur among women age 40 to 49.

“We know regular screening saves lives,” Wallace said. “The things that we catch on a screening mammogram are tiny.”

The task force said that when women start mammograms at age 40 they endure unnecessary imaging and that some mammograms lead to false positives and unnecessary stress.

The guidelines have sent a mixed message to some patients.

“We’ve gotten a lot of calls coming in from women who are scheduled to be coming in for diagnostic mammograms,” said Debbie Gardner, BSN, nurse educator in the breast center at Menorah Medical Center. “They want to know (if) they really need to keep these appointments because they are hearing things in the media about false positives.”

Gardner said the benefits of screenings outweigh the risks of a false positive.

During October, the staff at Menorah screened 976 women for breast cancer. Among those screened, 234 had abnormalities and 30 were suspicious, indicating the possibility of breast cancer. Nine of the suspicious results were in women under age 50.

“We feel like the answer to breast cancer is prevention and early detection,” Gardner said.

Mammograms are vital to early detection, said Angela Rupp, ARNP, a nurse practitioner at Gardner Family Care.

“Honestly, I probably won’t follow the new recommendations,” Rupp said. “I feel that screening is probably one of the most important keys to preventing the disease.”

Peggy Eldredge, RN, MS, AOCN, CBCN, APRN, oncology clinical nurse specialist and breast care nurse navigator at North Kansas City Hospital, agrees.

“I was very upset when I heard about (the new recommendations),” Eldredge said.

At North Kansas City Hospital, 40 percent of breast cancer patients are under age 50, Eldredge said.

“That’s not insignificant by any means,” she said. “We are not talking about a patient here or there.”

Eldredge said she and her colleagues will continue to recommend all women age 40 and older receive yearly breast cancer screenings.

“From our standpoint these are just recommendations and they are just from one organization,” Eldredge said.

Mammograms are not the only cancer screening to receive new guidelines last month. The American College of Obstetricians and Gynecologists issued new guidelines for pap tests that screen for cervical cancer.

The new guidelines recommend that women begin cervical cancer screenings at age 21, regardless of sexual activity. Old guidelines recommended that women begin cervical cancer screenings three years after they became sexually active or at age 21, whichever came first. The new guidelines also recommend that women age 21 to 30 have a pap test once every two years instead of every year. Women age 30 and older can be screened every three years if they have no abnormal history and have had three consecutive negative tests, according to the new guidelines.

American College of Obstetricians and Gynecologists said they issued these new guidelines because cervical cancer has proven to be a slow-growing cancer.

“Cervical cancer develops very slowly,” Eldredge said.

The human papillomavirus (HPV), which is spread through skin-to-skin genital contact, can cause cervical cancer. High-risk cases of HPV appear as cervical dysplasia and pre-cancer cells before cervical cancer develops.

According to womenshealthchannel.com, “it can take 10 years or longer for cervical dysplasia to develop into cervical cancer.”

Eldredge said the cervical cancer guidelines should take into account each woman’s sexual activity. For instance, women who are age 30 and older but have multiple or new partners should still be screened every other year even if they have had three consecutive negative tests, Eldredge said.

“That’s my only concern,” she said.

Rupp said she has concerns about women younger than 21 who are sexually active.

“I’ve had young girls with sexual activity as young as that who had high-risk HPV,” Rupp said. “I’m probably going to continue to recommend that they have paps done as soon as they become sexually active.”

Some health care professionals fear that both the breast cancer and cervical cancer guidelines could be used to create regulations among insurance companies.

“The problem with putting these guidelines out is that insurance companies latch on to them,” Eldredge said. “From my perspective it’s purely a cost-saving measure.”

Wallace said she thinks public pressure will ensure that insurance companies cover annual screenings.

“I’m hoping that won’t be an issue,” she said.

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