Despite new recommendations, the facts remain clear: breast cancer kills
and screening saves lives.
Self breast exams, clinical breast exams and yearly mammograms —
for many women these tests are a mainstay of their breast care.
These long-standing recommendations are now threatened, leaving many women
wondering how to be proactive about their breast health.
The American Cancer Society (ACS) in October introduced new breast cancer
screening recommendations. For average-risk women, the ACS recommends
yearly mammograms starting at age 45 — instead of 40 — and
biennially over age 54. The ACS also recommends against clinical and self-breast exams.
These guidelines join a growing list of conflicting screening recommendations
that frustrate women and health care providers alike.
Along with the National Comprehensive Cancer Network, American Congress
of Obstetricians and Gynecologists, and American College of Radiology,
Hoag Hospital remains steadfast in our belief that annual mammograms starting
at age 40 are the standard of care.
The reasoning behind the disparate recommendations is complex. However,
the following facts are fundamental to the debate over breast cancer screening:
1.) Breast cancer remains the second leading cause of cancer death in women.
2.) One in 8 women will develop breast cancer in her lifetime.
3.) Seventy five percent to 90 percent of women who develop breast cancer
are at "average risk."
4.) Screening mammography significantly reduces a woman's risk of dying
from breast cancer.
How much is a life worth? How accurate is the decades-old data on mammography?
Which cancers don't kill? Who will develop cancer? These questions
we cannot answer with certainty.
Risks and harms should always be considered. These include the potential
for "over-diagnosis" of breast cancer, false positive mammogram
results and financial burden. But when we couple the uncertainty and subjectivity
surrounding the screening debate with the unmitigated fact that screening
saves lives, the loosening of screening guidelines turns into a high-stakes gamble.
Aside from the cardinal focus on breast cancer mortality, early detection
often results in breast-conserving surgery, better cosmetic results, lower
treatment costs and potentially avoiding chemotherapy and radiation.
Mammography is not perfect. But two facts that cannot be overstated are
that cancer kills and mammograms save lives.
So the next logical steps in the fight against breast cancer are to improve
screening and focus on more effective and tailored treatments. Breast
tomosynthesis, or 3D mammography, is a great leap in this direction and
has been shown to increase the detection of invasive cancer by 40%, while
simultaneously reducing the rate of false positives. Couple this with
highly skilled, dedicated breast radiologists, and women experience less
anxiety and fewer biopsies.
Tens of thousands of women will develop breast cancer between the ages
of 40 and 44 this year. According to the ACS, most of them should forgo
screening mammograms and any form of breast exam. How will these women
be diagnosed? When their tumor is visibly deforming or when they develop
headaches from metastatic tumor?
We have the tools that save women's lives. We should be using them.
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Dr. January Lopez is the director of Breast Imaging at Hoag Breast Center.