Mammography before 40 or before 50? Incomplete data leads to incomplete conclusions

Ahhh. There’s the rub.

My breast cancer was found at age 49. My docs at M. D. Anderson Cancer Center told me that it had probably been there for at least two years. It hadn’t shown up previously in mammograms because it was a Lobular breast tumor - which are not easily recognized by mammography, and are easily found by ultrasound. This begs the issue - which I won’t go into here - of how my doctor marched his fingers right on across the breast with a 6 cm tumor (Stage IIIa) and ‘found’ a ‘problem’ in the opposite breast that needed an immediate mammogram.

Here are two differing views from experts on the morning shows-

First, Dr. Nancy Snyderman of the NBC Today Show ( due diligence: She’s a cardiac surgeon):

Next is a transcript from Dr. Jennifer Ashton on the CBS Morning Show (excerpted to save space here):

Now, says CBS News Medical Correspondent Dr. Jennifer Ashton, a new study of one million patients suggests that women in their 40s who have the exams can significantly cut their risk of dying of breast cancer.

The newest research is out of Sweden. It was, says Ashton, a practicing obstetrician/gynecologist, “a very large study, over a million women, did have its limitations, like every study. However, it found that women in the 40 to 49-year-old age group who had mammograms reduced their risk of dying of breast cancer by 26 percent.

“Again, I do not think this is a game changer; this is just another in the battle, ongoing debate over mammograms’ pros and cons.”

“But it is,” observed “Early Show” co-anchor Maggie Rodriguez, “in keeping with what we had heard for much of the time - that women in their 40s should have mammograms. And then, last year, this preventive task force changed it to 50. Why did they change it to begin with?”

“A lot of it has to do with science,” Ashton explained. “Mammography is not a perfect screening test. It has a lot of limitations involved. It has false positives — in other words, it can find things … that turn out not to be cancer. It has false negatives, meaning it can give you a normal result and there can still be a cancer there. Obviously, there’s cost involved.

Read the rest by clicking here.

What do I think? When Dr. Snyderman suggests that we needn’t get screening mammograms unless there is a family history or compelling risk factors, I suck in a deep breath.

I had absolutely no family history of breast cancer - or any cancer for that matter. So just what are we talking about as a risk factor?

I had been moderately overweight in my late thirties to mid forties. Then I lost all that weight. I did consume way more alcohol than the current thinking suggests I should have. I exercised and ate healthfully.

It’s easy to throw around statistics like you’d have to screen over 21 million women to find those few thousand with the deadly tumors - unless you’re one of those women with the tumor.

It’s also begging the reality that there are millions of women in THIS country - unlike Sweden or Norway with a national health program - that are not getting screening mammograms at any age due to having no insurance - or insurance that has no mandate offering them screening. Sharron Angle - Nevada’s candidate for U. S. Senate disapproves of mandates insisting that insurance companies offer women cancer screening, BTW.

If there might be an economic tie to the incidence of breast cancer occurence in the United States - due to the income level disparities of getting screening mammograms - we wouldn’t even know about it, since there are millions of women’s experiences that aren’t finding their way into the statistical data. And, having sat on a local hospital cancer committee, I can tell you that many communities have pathetically lame reporting of clinical outcomes. Too little data is going into the national cancer registries.

So any picture of the real cost benefit or actual clinical benefit here in the United States is woefully incomplete.

Until that statistical picture is really complete, I think we should err on the side of every woman getting an annual screening mammogram.

It saved my life.

Update on Friday, October 1, 2010 at 21:55 by mavenandmeddler

When I went to leave a comment on the Today Show site re the breast cancer segment, I saw the following comment by a Judy Wagner. She rocks.

Read on:

As a Former ICU Nurse, Cancer Survivor and Breast Cancer Patient Advocate it saddens me as a nurse of almost 45 years to see Nancy Synderman look into the camera and make a statement that the ACS and radiologists have a motive to do mammography. I entered medicine prior to mammography and my mother who was 43, was diagnosed when she found a lump the size of a large grape. Mammography did not exist and the cancer by then had gone to other areas. I on the other hand was diagnosed on a yearly screening when microcalcifications were found on my mammogram. This cancer had not formed a lump as yet and I had a lumpectomy. I am proud to say that since my diagnosis I have been an advocate for breast cancer and empowering women with knowledge as to the importance of mammograms as well as the importance of Centers of Excellence for breast care. See http://www.acr.org/accreditation.aspx. to locate an accredited facility in your area.

The Pioneers of Breast Cancer and Screening Mammography have changed the dynamics of breast cancer diagnosis and treatment as well as educating women why early detection saves lives. Do we want to go backwards and wait until breast cancer leaves the breast and invades the body before it is ever recognized?

As a former ICU nurse of 20 years with vast exposure to a plethora of disease entities and medical emergencies I have seen medicine evolve. Cataract surgery in my early practice required complete bed rest for 24 hours with sand bags on each side of the patient’s head to prevent any head movement. Now cataracts patients are Day Surgery and home in a couple of hours.

I have experienced a time when breast cancers eroded through the breast before treatment was received. In 3^rd world countries this is still happening today. Dr Synderman whose medical expertise is ear, nose, and throat surgery professes to be an expert in mammography and its importance. She talks down to Mammography experts who have done Screening Mammography Studies such as Dr. Laszlo Tabar of Sweden and Dr Dan Kopans who are among those radiologists who have dedicated their total careers to Breast Care and its evolution. How dare her make an accusation that the American Cancer Society and the American College of Radiology have a conflict of interest and that mammography is money motivated. This is a very sad commentary coming from someone who is not an expert in breast care. Not only that she is a woman, and has a daughter that she recommends not getting a mammogram or doing self breast exams as per the Task Force Recommendation. I believe that young women who have been diagnosed with breast cancer before 40 and have experienced the importance of quality breast care would debate Dr. Syderman. It is due to those radiologists, who have pioneered screening mammography and other imaging intentions ( ie. Breast Ultrasound, Breast MRI and image guided breast biopsies) that have made the difference in the lives of women.

She also mentions the accumulative effects of a yearly mammogram. I think before she speaks on radiation dosage she should have facts before throwing out a statement without factual statists.

I do hope that Dr Synderman’s daughter is fortunate to not experience any breast problems since her mother is extolling the recommendations of the Task Force. That would mean she would not have a mammogram until she is 50 nor do monthly self breast exams. Hopefully she will be forward thinking and do research before she follows her mother’s lead.

Myth #2: Mammograms can only help and not harm.

Let me make a note here: I’ve watched in dismay and horror as far too many women have allowed themselves to be frightened by one mammogram into a biopsy - and sometimes a surgical, invasive biopsy at that - or even a mastectomy on the basis of just one damn mammogram! It’s wrong.

Mammograms can be inaccurate or misinterpreted. Not all mammograms are created equally. The machines might be state of the art, but the technician might not be. Taking a good mammogram is equal parts art, science and experience. The same can be said of the radiologist reading them. If the radiologist is looking at broken bones and gall bladders as often as breast mammography, there may not be the critical level of experience you need before deciding a course of action.

A second or third mammogram, or ultrasound may be required. Even an MRI may be needed. And you should seriously consider getting them at a different facility and read by a radiologist that does only breast mammography. Think there’s nobody like that? Think again.

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