Scaring young women raises concern under breast cancer awareness plan

If it becomes law, a bill currently sitting in Congress designed to increase breast cancer awareness and prevention among women aged 15 to 39 could lead to a significant jump in the number of screening exams. Whether these exams would be medically warranted or just motivated by fear, breast imagers say, is open to question.

In March, Rep. Debbie Wasserman Schultz (D-FL) introduced the Breast Cancer Education and Awareness Requires Learning Young (EARLY) Act of 2009. The law calls for $9 million in appropriations to finance education among premenopausal women and support for young victims of the disease. Act proponents argue the current approach, annual screening mammograms starting at age 40, promotes complacency among young women, some of whom discover the first symptoms of the condition at a much younger age.

Critics of the bill argue that early mammograms could expose young women to other risks, such as cumulative radiation exposure. Radiologists and radiation experts prefer to tone down these concerns, saying they are unsupported by data.

Breast imaging proponents acknowledge the legislation could open the door to a wave of unnecessary procedures, however. According to Pamela A. Wilcox, RN, the American College of Radiology assistant executive director of quality and safety and a member of the ACR's breast imaging commission, the legislation could lead to increased screening.

"Whether it's appropriate screening or not would be our concern," Wilcox told Diagnostic Imaging.

Radiologists do not want to see young women get in a panic and undergo imaging every time they feel something, especially considering their breasts tend to be dense and prone to lumps and bumps. If the bill becomes law and there is a national breast cancer education campaign, it must be done judiciously, Wilcox said.

Other features in the legislation, including educating high school-aged girls about general health issues -- especially nutrition, exercise, and safe sex -- is good, said Dr. Matthew Gromet, section chief of breast imaging at Charlotte Radiology in Charlotte, NC. But teaching breast self-examination will not lead to any benefits; many benign lumps may lead to unneeded biopsies, Gromet said.

One issue addressed by the act, better understanding of family history risk factors, makes a lot of sense to scientists and physicians, as certain individuals may benefit from genetic counseling and possibly genetic testing, Gromet said.

"Risk assessment is going to be a crucial endeavor in breast cancer research and management," he said.

The bill may never make it out of Congress, though. It cleared the House floor with more than 360 votes, but it is stuck in the Senate. And the $9 million tab may stick in the craw of lawmakers who are already trying to figure out how to pay for healthcare reform, Wilcox said.

If it passes, however, the bill may draw extra strength from a white paper by the ACR and the Society for Breast Imaging that will provide guidance to women and their physicians on when to start screening based on individual risk. The paper is due for publication early next year, Wilcox said.

"If this bill passes, we would hope that the advisory committee that's mentioned in the legislation would include breast imaging experts from the ACR," she said.