To Screen or Not to Screen: The Mammogram Conundrum

For many women, getting a mammogram is already one of life’s more stressful experiences. Now, women in their 40s have the added anxiety of trying to figure out if they should even be getting one at all.”
~ Jocelyn Noveck, AP, 18 November, 2009.

Since the news broke earlier this week that most females should wait until age 50 to get mammograms, women have been trying to sort out conflicting advice about when to begin breast cancer screenings. According to the U.S. Preventive Services Task Force made up of expert independent doctors and researchers from prestigious university medical institutions and comprehensive cancer centers like Johns Hopkins, Dana Farber, Georgetown, Harvard, Duke, MD Anderson, etc., the scientific evidence has proven that most women do not need routine mammograms in their 40s and should get them only every two years starting at age 50.

In a break with the American Cancer Society’s long-standing position, the panel of doctors and scientists concluded that such early and frequent screenings often lead to false alarms and unneeded biopsies, without substantially improving women’s odds of survival. (Screening for Breast Cancer, Topic Page. November 2009. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD.(http://www.ahrq.gov/clinic/uspstf/usbsbrca.htm) “The benefits are less and the harms are greater when screening starts in the 40s,” stated Dr. Diana Petitti, vice chair of the panel.

The recommendation was based on the panel’s review of a large body of research indicating that for women under 50, mammograms have saved only one life out of 1904 screenings. For that one woman, that may be good enough. But this issue is about scientific data, not anecdotes. The scientists concluded that because of greater breast density, mammograms in the 40-49 year age group tend to produce many false positive and false negative readings. This
causes doctors not only to miss breast lumps, but especially to overcall them – which leads to unnecessary irradiation, biopsies, and anxiety that potentially have undesirable cumulative effects on women.

The panel’s new recommendations are more in line with international guidelines, which call for screening to start at age 50. The World Health Organization recommends the test every two years, and Britain says every three years. Furthermore, in the U.S., screenings for prostate and colorectal cancers routinely start at age 50. Nonetheless, Health and Human Services Secretary Kathleen Sebelius insisted that women should continue getting regular
mammograms starting at age 40, and the American Cancer Society ‘s chief medical officer, Dr. Otis Brawley, maintains that routine mammograms for women ages 40 and up save lives.

The task force report has left women across the country confused about which advice to take. The report also quickly led to charges from opponents of health care policy change that it is a prime example of what could be expected from government-managed care. The reversal of the mammography mandate for 40+ year olds has been seen as “rationing” or as an example of government trying to interfere with women’s health. Yet according to NBC’s medical correspondent, Dr. Nancy Snyderman, this fall’s incessant “pinking of America” has been over-marketed, over-emotionalized and now over-politicized. Under-50 females are not only feeling confused, but also deprived, cheated, and even panicked.

Here’s our take on the issue: Let go of all the malaise about screenings. First, as Sibelius stated, the task force does not set federal policy and they don’t determine what services are covered by the federal government or by insurance companies. Women should talk to their doctors about their individual history and risk factors and make the decision that is right for them.

Second, if women do want to get screenings, thermography (infrared breast imaging) is an excellent screening tool that is safer and more efficient than mammography for early detection of breast disease. Thermograms (heat pattern photos) are non-invasive, painless (there is no compression) and radiation-free (radiation is a risk factor for breast cancer). They are over 97% accurate in the early detection of breast cancer, and there are over 800 peer-reviewed studies about the effectiveness of thermography, which has been FDA approved since 1982.

Finally and most importantly, early detection is not your best protection at any age. It’s better than late detection, but it is not the same as true prevention. There is already ample scientific evidence that diet and lifestyle choices dramatically influence both risk for breast cancer and outcome for diagnosed patients. The National Cancer Institute estimates that breast cancer deaths avoidable through dietary change run as high as 70%. In The China Study, the world’s most comprehensive study of diet, health and disease ever completed, lead researcher Dr. T. Colin Campbell states, “No matter if both your grandmothers died of breast cancer, you may have the power to help avoid playing out this genetic tendency.“

In actuality, genes are responsible for only five to ten percent of breast cancers (Centers for Disease Control, www.cdc.gov/genomics), and all classically recognized risk factors (other than being female) account for only 20 to 25 percent of breast cancers diagnosed in the U.S. (Dr. Jerome Levy, Your Breasts and Dr. Susan Love, Dr. Susan Love’s Breast Book).

For these high-risk women, doctors generally recommend more frequent and more intensive monitoring than for other women, chemoprevention through drug therapy, or prophylactic surgery to remove the breasts as a preventive. For many women, these options are not particularly attractive, nor do they totally remove the risk. That’s the bad news.

The good news is that scientific research has demonstrated dramatic ways in which dietary choices can affect risk for breast cancer – by influencing not only genetic expression, but also estrogen levels and immune function. Whether a woman is at high risk with known genetic damage or whether she is only at moderate risk (nearly one in seven of all US women will be diagnosed with breast cancer), wise food choices can help improve the odds in her favor.

In conclusion, mammograms can provide valuable corroborative information, but frequent and early screenings may be needless procedures, provide inaccurate information, or actually cause harm. There is sufficient scientific data on diet and lifestyle factors to empower women with their most valuable prevention tool, and counselors at the Center for Advancement in Cancer Education are experienced in helping women find practical ways to apply that research to their daily lives. Call 888-551-2223 to schedule an individualized consultation.

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