During October’s Breast Cancer Awareness Month, the issue of mammography
for women is again top of mind. Many recent announcements and studies
about new mammography screening guidelines has generated considerable
confusion about the role of mammography and could reverse years of education
and behavior modifications about breast cancer screenings. Confusion abounds.
Many of our patients ask me about them. “Should I or should I not”
is a pretty much a staple question doctors like myself and my colleagues
get very day, day in and day out. I suspect physicians around the country
get the same comment from their women patients as well.
Until 1990, the breast cancer death rate in the U.S. had remained unchanged
for 50 years. With the introduction of screening mammography, there was
an abrupt and sustained decrease in the breast cancer death rate by 30%
over the past 20 years.
The US Task Force on Breast Cancer recommends against routine screening
mammography for women ages 40-49. However, there is significant scientific
evidence that women in their 40s can expect an equivalent decrease in
breast cancer mortality due to screening mammography as compared to women
50 and older.
The incidence of breast cancer rises steadily with age, but there is no
dramatic increase at age 50. The probability of being diagnosed with breast
cancer among women in their 40s is 1.44% as compared to 2.63% among women
in their 50s. Moreover, it has been estimated that 40% of the years of
life saved by screening can be attributed to women diagnosed under the
age of 50.
The Task Force only advises those women in their 40s who are at high risk
to undergo screening. However, it should be emphasized that only 10-25%
of breast cancers occur in women at high risk. The majority of breast
cancers arise in women with no special risk factors.
Yearly screening may be especially important for younger women because
they tend to have faster growing cancers. Lengthening the screening interval
to 2 years will reduce the survival benefit for all women and ultimately
contribute to more treatment related side effects because more cancers
will be diagnosed at a later stage.
Physical exam, whether practiced by a woman herself or her doctor, will
always be key to any breast imaging technique. Women should remember to
bring any changes to their doctor’s attention. We can each recall
personal instances where a woman’s own self exam led her to a doctor
for follow up, sometimes with life-saving outcomes.
The new guidelines are just that, guidelines. The best bet is to talk to
your own doctor about your risk factors and make a decision together about
your breast health; it may save your life.
(Dr. Jim Wallman is a radiologist at Redlands Community Hospital)