by Sarah Faitak
Recent studies may have caused you to question the importance of having yearly breast screenings. In this blog Sarah Faitak, RN, Breast Imaging Nurse at The Breast Center, addresses the latest studies, screening options and other common questions from women about breast health.
What could be more frightening than being told your mammogram was not “normal?” With all the hype about breast cancer, it must be a scary disease, right?
For the last several years pink ribbons are found on every product imaginable, reminding us that breast cancer exists. Luncheons, golf tournaments, rodeos, baseball games, races, virtually every activity you can imagine has occurred to raise money for breast cancer.
Yes, breast cancer is scary and has caused far too many of our mothers, wives, daughters, sisters and friends to die. Here is the good news: the chance of dying from breast cancer has been significantly reduced with screening mammograms. When found early through screening, survival rates for breast cancer are as high as 95% or more. Mammography screening saves lives.
1. I have read that mammography may be overused. Is that true?
Two recent publications have brought up questions about mammography. 1) H. Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, authored an article “Overdiagnosed: Making People Sick in the Pursuit of Health,” questioning the use of screening mammograms and over treatment of breast cancer. 2) More recently, Lydia Pace from Brigham and Young Women’s Hospital wrote an article published in JAMA titled “Stop One-Sized -Fits-All Mammography ” claiming the harms of screening may outweigh the benefit.
While those in medicine should always consider their oath to “do no harm” and continually question their practice, in the instance of screening mammograms, both authors come to their conclusions by reviewing previous studies with questionable scientific technique. For instance, both authors use data from a study done in Canada in the 1980s. A screening mammogram is an exam performed on an asymptomatic woman, meant to detect cancer before symptoms are present. However, the Canadian study did not have individual patient information to separate those who had symptoms from those who were asymptomatic. Welch and Pace subsequently conclude that screening mammograms are ineffective after reviewing the mixed bag of symptomatic and asymptomatic women. In addition, since the 1980s when the Canadian study was done there have been many advances in x-ray technology that produce far superior images and have improved detection of small cancers over the previous method.
Contrary to the claims of Welch and Pace, there is overwhelming evidence in multiple major studies performed all over the world using exemplary research techniques that show screening mammograms find small, early cancers, can reduce the extent of treatment needed, and save lives.
- Lazlo Tabar of Sweden, often considered the father of screening mammography, published data in 2011 from over 29 years of prospective research that shows that screening asymptomatic women has reduced the deaths from breast cancer by 30%.
- The “harm” Welch and Pace claim that comes to women who have screening mammograms are the additional mammograms, ultrasounds and occasional biopsies that prove the original finding was benign. Perhaps the question should also be, “what harm is there for the woman in whom cancer is not found early through screening?” When breast cancer is found early, the patient most often can avoid chemotherapy and extensive surgery and has a much higher rate of survival than when the cancer is found later, when symptoms arise.
2. What, exactly, do the studies conclude to be the recommendations for screening mammograms? At what age does one begin and how often should they be done?
Based on the research from Tabar and others, most professional groups, like the American Cancer Society and the National Comprehensive Cancer Network, recommend that women begin having screening mammograms at age 40 and have them annually as long as they are healthy.
It is true that “One-Size-Fits-All” recommendations do not serve all women. Recommendations from breast health groups agree that those with a strong family history of breast or ovarian cancer or those with dense breast tissue may need to start screening earlier than 40 or have more extensive screening tests, like breast MRI and screening ultrasound, to assure that they are adequately screened for breast cancer. Each woman should decide with her physician whether or not her history indicates she is high risk.
3. Should I be frightened when told my yearly screening mammogram is not “normal?”
Not yet. You should follow up with the additional studies, and you will likely be in the majority of women who are eventually told the finding is normal.
4. Should I be frightened of dying of breast cancer?
Well, you should be concerned enough to follow the recommendations of your physician and radiologist for screening and diagnostic studies, knowing that the best cure for cancer is to detect and treat it early, before it spreads. The chance of dying from breast cancer has been significantly reduced with screening mammograms. When found early through screening, survival rates for breast cancer are as high as 95% or more.
5. How does the average woman tell the difference between good research and biased opinions? With conflicting advice arising regularly, whom do I believe?
It is sometimes hard to sort out sound recommendations from those that merely get attention from the media. National organizations like the American Cancer Society and the National Comprehensive Cancer Network look at many different studies and compare the quality of the research to come up with their recommendations. Talk with your physician about your questions and concerns. And remember, diagnosing cancer early is the key to less extensive treatment and a more likely cure.
Sarah Faitak, RN, has over 10 years of experience working as a breast imaging nurse and is the Director of The Breast Center of Northwest Arkansas, a MANA Clinic.
If you have questions about what screening is right for you, you may want to consider a breast cancer risk assessment appointment to meet with a trained nurse to discuss all the options, your family history, and personal risk factors.