BY KATE BUNSTER
NISKAYUNA — Dvora Koelling was in her car listening to NPR when she heard the news. Her heart sank.
It was Oct. 20, and the American Cancer Society had announced its revised guidelines for recommendations on breast cancer screenings and clinical exams. Under the new guidelines, women are advised to begin screenings at age 45 instead of 40.
“I almost needed to pull over,” said Koelling. “It was such a gut reaction.”
Koelling is 40-year-old mother of two living in Niskayuna. Her mother, Sandy Greenberg, was diagnosed with Stage 2 cancer at age 44. After 10 years in remission, the cancer returned and she lost her battle when it spread to her internal organs at age 63. Had Greenberg followed the new guidelines and waited until she was 45 to get screened for breast cancer, it might have been much more advanced and harder to treat.
Through her diagnosis, Greenberg learned there was a genetic mutation in her BRCA1 gene.
BRCA genes serve to repair damaged DNA, according to Memorial Sloan Kettering Cancer Center. When mutated, the cells are unable to fight off cancer effectively, causing women with the gene mutation to be at a higher risk for cancer.
“I understood [the new guidelines], but I couldn’t reconcile,” said Koelling, who underwent a preventative mastectomy in February 2015 after testing positive for the BRCA1 mutation in 2011.
She created a petition on Change.org to reverse the American Cancer Society’s recommended age for starting breast cancer screenings back to 40. To date, the petition has 2,742 signatures.
The guidelines, which hadn’t been updated since 2003, were based on the ACS’s latest research and published in the Journal of the American Medical Association.
The ACS raised the recommended age for first mammogram to 45 because screening at a younger age results in a greater number of mammograms over the lifetime, and a proportionally greater risk of one of them providing a false positive. The study mostly focused on film mammograms, however, as opposed to digital mammography, which is now more commonly used and more accurate, according to Koelling. This is the source of much of the controversy and criticism.
Breast cancer mortality has dropped 35 percent due to early detection, according to Dr. Sara Raymond, a radiologist at Ellis Medicine’s Bellevue Woman’s Center. Some question whether this percentage would be as good under the new guidelines, though.
“The ACS believes that the risks of anxiety caused by callbacks and false positives/overdiagnosis outweighs the benefits of the lives that would be saved through mammogram detection of breast cancers in women 40 to 45,” said Koelling.
Another significant change to the updated guidelines is that clinical breast examinations — a manual check by a doctor or other health professional — are no longer advised for average-risk women of any age.
The standards that qualify a woman as average and high-risk are set by the American Cancer Society and take into account personal and family medical history.
Ellis’ website highlights the new ACS guidelines, but still encourages caution, stating: “You should ask your doctor or healthcare provider what is right for you.”
The ACS website backs this up, stating that at age 40, women should “have the opportunity to begin screening” after talking with their doctor.
But Koelling believes that these guidelines aren’t clear enough. “These recommendations devastated many people,” she said. “I would like to see more conservative guidelines that watch out for the greater good.”
Koelling is a part of support groups for women who have been diagnosed with breast cancer and are living with the BRCA mutation. She has been overwhelmed by the number of women who were diagnosed with breast cancer before age 45. They feel grateful, but find it unsettling that had these guidelines existed previously, they might not have been treated in time.
Approximately 26,000 American women under the age of 45 are diagnosed with breast cancer each year, according to the Maurer Foundation for Breast Health Education.
About 77% of women are above the age of 50 when diagnosed with breast cancer, according to the U.S. Department of Health.
“Many of us cannot fathom why the American Cancer Society would come out with new guidelines that ignore this simple statistic,” said Koelling.
Though she admits she is not a doctor, she doesn’t need to be one to pursue her goal: to allow women and those affected by the regulations to have a voice.
BY KATE BUNSTER