When the medical world agreed that mammography and breast self exams were a good thing, the whole discussion turned upside down with a recent publication in the British Medical Journal, that suggest that mammography is no longer necessary. This article will discuss that report and provide advice for women so that they may make the best decision regarding their screening for breast cancer.
What is mammography?
A mammogram is an x-ray picture of the breast. It can be used to check for breast cancer in women who have no signs or symptoms of the disease. It can also be used if you have a lump or other sign of breast cancer.
In the past screening mammography is the type of mammogram that checks a woman when she has no symptoms. It was thought that screening mammography would reduce the number of deaths from breast cancer among women ages 40 to 70. But it can also have drawbacks. Mammograms can sometimes find something that looks abnormal but isn’t cancer. This leads to further testing and can cause a woman significant anxiety. Sometimes mammograms can miss cancer when it is there. It also exposes the woman to radiation. The National Cancer Institute recommends that women age 40 or older have screening mammograms every 1 to 2 years.
How is a mammogram performed?
In a screening mammogram, each breast is X-rayed in two different positions: from top to bottom and from side to side. When a mammogram image is viewed, breast tissue appears white and opaque and fatty tissue appears darker and translucent.
How does it differ from breast self-examination?
A breast self exam is a check-up a woman does at home to look for changes or problems in the breast tissue. Many women feel that doing this is important to their health.
However, experts do not agree about the benefits of breast self exams in finding breast cancer or saving lives. Most organizations and doctors believe that breast self-exams have little value, based on findings from several large studies. However, this is far better than no examination or no mammography at all.
Talk to your health care provider about whether breast self exams are right for you.
The best time to do a self-breast exam is about 3 – 5 days after your period starts. Your breasts are not as tender or lumpy at this time in your monthly cycle.
If you have gone through menopause, do your exam on the same day every month.
What did the recent report say about mammography?
One of the largest and most meticulous studies of mammography ever done, involving 90,000 Canadian women age 40-59 and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age.
It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation.
The study, published in February 2014 in The British Medical Journal, is one of the few rigorous evaluations of mammograms conducted in the modern era of more effective breast cancer treatments. It randomly assigned half of the women to have regular mammograms and breast exams by trained nurses or to have breast exams alone.
The death rate from breast cancer was the same in both groups, but 1 in 424 women who had mammograms received unnecessary cancer treatment, including surgery, chemotherapy and radiation.
The findings of this study will not lead to any immediate change in guidelines for mammography, and many experts will dispute the idea that mammograms are on balance useless, or even harmful.
So what is a woman to do?
The American Cancer Society recommends yearly screening mammograms starting at age 40. However, the U.S. Preventive Services Task Force (USPSTF) does not recommend screening for women in their 40s. For women between the ages of 50 and 74, USPSTF experts say women should have mammograms every two years and do not recommend screening at all after age 74. The American Cancer Society and the American College of Obstetricians and Gynecologists suggest that woman consider screening mammograms beginning at age 40.
It is noted that women whose tumors are discovered through mammography are smaller and present at earlier stages and are more likely to undergo breast conservation therapy, i.e., lumpectomy and women who have their cancer identified through breast self examinations tend to have more advanced cancer and have mastectomies or the entire breast removed.
When you need a mammogram is a personal decision between you and your doctor. If you’re over 40, talk to you doctor about when you should begin mammogram screening.
Bottom Line: Breast cancer remains the most common cancer in women and early detection is important for improving outcomes and saving breast tissue, i.e., having a lumpectomy instead of a mastectomy. I encourage each woman to have a discussion with their doctor about when to begin screening for breast cancer and whether or not to screen with mammography.