Wednesday, October 26, 2011

Breast Cancer Screening Update

In 2009, the US Prevention Service Task Force (USPSTF) a government agency, issued new recommendations  for mammograms and breast cancer screenings. This controversial new recommendation suggested women younger than 50 without a family history of breast cancer didn't need an annual mammogram. They also recommended that screening exams for women between 50 and 74 were needed every OTHER year, not annually. This reversed the USPSTF's 2002 recommendations and went against the American Cancer Society and the American College of Radiology, both of which recommend baseline mammograms at age 35 and annual screenings of ALL women after age 40. There's also no cut off age, as healthy women in their  early to mid 80's should still have mammograms.
The USPTF's recommendations to NOT screen before age 50 was based on a study that showed screening 1,330 women over age 50 saved one life but it took 1,904 screening mammograms to save the life of one woman in the 40-50 age group.  Hmm. I'm betting that one woman was damn glad she got screened!
The agency also suggested that screening led to false positives which then led to negative biopsies. They implied the biopsies were unnecessary. I don't know about you, but I'd rather have 4 negative biopsies than 1 positive one. Oh. Wait. I've had one of each. And let me tell you, after being diagnosed with breast cancer in 2007, I was relieved my 2008 biopsy was negative. 

The thing is, doctors are not going to biopsy women willy nilly. If a doctor recommends a biopsy, it's because the radiologist saw something suspicious in the breast. It may turn out to be a cyst, lipoma, fibroadenoma, inflammation, or fibrocystic changes. But it could also be cancer. I'm not willing to bet my life on it and I don't think most informed women would either.
The truth is, doctors have been ordering mammograms since the 1940's but it wasn't until the 1990's that the government (and insurance companies) recognized the need for early detection and the need for screening mammograms.  From 1940 to 1990, the death rate from breast cancer remained unchanged. From 1990 to present day, more women are getting screening mammograms and the death rates from breast cancer have decreased by 30%. That in itself says a lot about the need for early detection. Also, breast cancer is usually more aggressive in women younger than 50. 

Honestly, I think extending the life expectancy of everyone is a good idea, but it is an especially good idea for women under 50. Early detection saves lives and women in a breast cancer screening program who are diagnosed with breast cancer are more likely to be diagnosed in stage one than women who find a palpable lump. Any woman who has annual clinical breast exams and a mammogram is in a breast screening program. And the program works better if the patient has their mammogram at the same facility each year. 
If you decide to change facilities, remember to have your prior mammograms sent to the new facility.
Many doctors have chosen to ignore the US Prevention Service Task Force's mammogram recommendation. Unfortunately, the task force recently denounced self-breast exams. The agency claimed women didn't know how to do them and would therefore, stress needlessly if they found a lump that was actually normal glandular tissue. Now imagine how much more stress those women would undergo if they followed the government guidelines and stopped doing self-breast exams and were later diagnosed with breast cancer after the doctor found a palpable lump on clinical breast exam. I'm betting most women would rather find a lump that wasn't a lump than not find a lump that was cancer.

So please, follow the recommendations of The American Cancer Society, The American College of Radiology, The FDA, and a mammogapher who happens to be a breast cancer survivor. If you are older than 20, do self breast exams. If you are older than 25, have your doctor or medical health provider do a clinical breast exam each year. If you are 35, have a baseline mammogram and then once you turn 40, have a mammogram every year. If you find a lump, have unilateral nipple discharge that is bloody or green, see your doctor. If you have a mother diagnosed with cancer before age 50, subtract 10 years from her age and that is when you should have your first mammogram.
Know your breast. Be informed. And get screened!


  1. Great post. You do a service to all of us.

  2. The reality check article is NOT supported by most medical oncologists, radiation oncologists, mammogaphers, The American Cancer Society, or The American College of Radiology.

    Welch said "it's important to remember that of the 138,000 women found to have breast cancer each year as a result of mammography screening, 120,000 to 134,000 are not helped by the test."

    I have to ask, how did discovering a breast cancer in an asymptomatic patient on a screening mammogram NOT help? I had an invasive carcinoma that was triple negative. No lump. No pain. No symptoms. Had I waited until there was a lump to have my mammogram, my survival rate would have been around 5-10%. Because it was detected early, my survival rate is 90% and increases at 5 years and 10 years as long as there isn't a recurrence.

    Welsh also said, "First, there are non aggressive cancers that would be found and successfully treated with or without screening."

    How's he going to find them? The only way to diagnose breast cancer is with a biopsy and unless it's a huge, palpable mass, no doctor is going to perform a biopsy without first ordering a mammogram or ultrasound.

    He also said, "Then there are aggressive cancers, so-called bad cancers, that are deadly whether they are found early by screening, or late because of a lump or other symptoms. Women with cancers in either of these groups are not helped by screening."

    I beg to differ. Women in these groups can and do survive. I had a bad, aggressive cancer. I survived. Those who don't often extend their lives--their children have time to grow up--because the mammogram diagnosed that cancer sooner than if they'd waited to find a lump. No mammogram is going to improve the survival rate for inflammatory breast carcinoma. Then again, that's not really considered a curable form of breast cancer. But the sooner it's treated, the longer the survival. Do you know anyone who'd opt to die sooner without a fight?

    I won't argue the controversy of DCIS. But removing it via a stereotactic biopsy doesn't seem like over treatment.

    And I won't argue the fact that some ill-informed women mistake screening for prevention. I leave that up to their doctors to educate them.

    I will also not argue the fact that a lobular carcinoma in a woman with dense breasts is likely to be missed on mammogram and quite possibly on an ultrasound as well, giving the woman a false sense of peace when she actually has breast cancer. Hence the need for self breast and clinical breast exams. A lump that gets bigger and doesn't show up on mammogram should be sampled and biopsied. Because a biopsy is the ONLY way to detect breast cancer.

    And FYI, 3D tomosynthesis, the next generation in digital mammography, is currently in the FDA approval stages and will improve the radiologists' ability to more accurately diagnose breast cancer on a mammogram--even lobular carcinomas in women with dense breasts.

    I didn't just read an article and re-state it as an unarguable fact. I admit, having an aggressive breast cancer diagnosed on a screening mammogram solidified my opinion. But I'm not just a breast cancer survivor. I'm a mammogapher. I KNOW screening mammograms save lives. Because I x-ray the breast cancer survivors every year. And I see the patients that are dying of metastatic disease because they never had a mammogram until they found a lump and by then, it was too late.

    So, thank you for suggesting I get a reality check, but I had one the day I saw my own cancer on a screening mammogram before the doctor ever read the films.

  3. It's scary to see how government cuts its dollars. I turn 35 in January (tell anyone and I'll deny it), and plan to get my first booby squish. I don't look forward to it, but I want to be around to raise my children. Thanks for the great post.

  4. Excellent post, Lilly. Pay no attention to the man behind the curtain. He's an idiot. I didn't do self exams and consequently faced stage three instead of one. And if we followed the new recommendations, my sister, my cousin, and me would probably have ended up as statistics as we were all over 40.

  5. Andris,
    It's not that bad. Really. And regardless of what some people think, mammography does have the potential to save your life.

    Lol! Mac. Yes this is my soapbox and not just because I was diagnosed with breast cancer after a screening mammogram at age 47. But because I am a mammographer and I've seen so many women diagnosed at later stages because they skipped a couple of years or because they never had a mammogram at all until they had a lump.

    Breast cancer is "staged" based on the extent of the cancer in the body--whether it's invasive or non-invasive, how aggressive the tumor is, the size of the tumor, how many lymph nodes are involved, and if it has spread to other parts of the body.

    A stage one cancer is less than 2cm--often too small to feel. But it can be detected on a mammogram. And early detection is an important factor in determining prognosis and treatment options. The earlier, the better.

    Just ask the radiologist I work with, my friend who is a dosimitrist, my other friend who is a radiation oncologist, my daughter who is a radiation therapist, my family doctor, my medical oncologist, my radiation oncologist, my fellow mammographers, my surgeon, The American Cancer Society, The FDA, any woman diagnosed with breast cancer or anyone who loves someone who's been diagnosed with breast cancer.

    And don't think men are safe. Men account for 1% of breast cancer. It's usually diagnosed in the later stages and percentage wise, the cure rate is not as good as in women because men don't get screening mammograms. However, men do get mammograms if they feel a palpable, unexplained mass in their breast.

    How do I know? I've done approximately 8 mammograms on men in the past 6 years and one of those mammograms resulted in a positive biopsy--with lymph node involvement.

  6. Thank you for this information. I've had questionable mammograms and had to have repeat films plus a whole lot more - they stretched my breast in ways I didn't think was possible. Got ruled out from lump to lymph node (normal). Those few days were incredibly nerve wracking. My heart goes out to everyone who has gotten the tough diagnosis. Medicine isn't an exact science.
    However, this is one more reason I feel the government should stay out of medicine. Let the medical professionals set guidelines, not the government.

  7. Absolutely! Thanks for commenting, Lynne.