Breast cancer is still the most common cancer among women and remains the second leading cause of cancer death for women in the United States. The American Cancer Society (www.cancer.org) estimates about 40,000 women will die of breast cancer this year, including about 40 Dutchess County residents.
Mammography has been a mainstay in our efforts to detect and treat breast cancers at the earliest possible stage in order to provide the best possible outcome for a patient.
There is widespread agreement that mammography, over the past 50 years, works. It has detected millions of breast cancers early for women ages 50-74. Lives have been saved.
There has been recent scientific disagreement whether widespread use of screening mammograms should be used in women ages 40-49 and age 75 and over. Why?
History of mammography
Although originally introduced in the 1920s in an effort to diagnose breast cancer, the modern-day mammogram and mammography programs were not developed until the 1960s. Screening techniques continued to be perfected with reduced levels of radiation needed for the test as we moved into the 1980s. Sonograms and breast MRIs were later introduced to aid in greater detailed examination of the breast tissue if an abnormality was detected. During the mid-1990s, digital mammography took hold, providing even greater image resolution with continued reductions in radiation exposure for each exam. The popularity of mobile mammography vans that surged in the '80s and '90s is now fading as experience has shown great variability in quality. Tests were not to be as reliable as those that were done with equipment in a consistent location.
More evidence mammograms in one's 40s do more harm than good: Mammography is supposed to detect breast cancer at the earliest possible stage — for the earliest possible treatment and cure. However, researchers say that too much screening does not accomplish that; it leads to over-diagnosis: mammography finding abnormalities, or even slow-growing benign cancers, that would not cause illness or death. Treating those "non-lethal" mammography discoveries means unwarranted and unnecessary surgery, chemotherapy and radiotherapy. The latest review of research shows that over the past 50 years over-diagnosis may harm seven times as many women as would be saved from breast cancer death (36/10,000 vs. 5/10,000). The authors of the review in the Journal of the American Medical Association note that while mammography continues to be an important tool in the fight against breast cancer, over the past five decades we have been overestimating its value and underestimating its harms. They conclude that mammography screening needs to be an individualized decision between a patient and her or his doctor with the full understanding of all the risks and benefits of screening at specific times in their life.
This is not a new issue, but it is of great importance and continued debate. Though cited in Journal of the American Medical Association, The American Cancer Society still has the opposite point of view. The American Cancer Society states that, "The chance of a woman having invasive breast cancer during her life is about 1 in 8. The chance of dying from breast cancer is about 1 in 36. Breast cancer death rates have been going down. This is probably the result of finding the cancer earlier and better treatment. Right now there are more than 2.8 million breast cancer survivors in the United States."
On the other hand, the U.S. Preventive Services Task Force does not endorse routine screening for women 40-49. They say these tests need to be individualized to patient risk. The American Cancer Society disagrees and still recommends an annual mammogram screening test for all women 40 and older. Who should you listen to? It is best to learn all you can about the variability in recommendations, understand the benefits and the risks and make a personal decision with your doctor about what you feel is the right choice for you.
Breast cancer risk increases with age. The older you are, the greater your risk for breast cancer, but also for cancer in general, as well as the risk for heart disease and other illnesses. So, the U.S. Preventive Service Task Force has said there is still not enough science to confirm that annual breast exams for women over 75 is worth the risks of over-diagnosis and over-treatment. Best bet — make sure you work closely with your doctor to make the choice that is best for you.
We continue to try to identify modifiable risk factors so that women can lower their risk of breast cancer. One of the biggest risk factors: Alcohol. Yes, it may reduce your risk of heart disease, but there appears to be no safe level of alcohol consumption to avoid increasing your risk of breast cancer.
Today is Mother's Day. Do your part and make sure your mom has an appointment with her doctor to make sure she is up to date with her breast cancer screening test. Breast cancer screening saves lives when used appropriately.
Dr. Michael Caldwell is a fellow in public health leadership at the Harvard School of Public Health and is the former Dutchess County Commissioner of Health.