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Do you need regular mammograms?Ronald Porep, Safetyissues |
Volume 1 Issue 4March 2002 |
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Do you need a regular mammogram? Medical studies in the 1970s and '80s concluded that they save lives, and that regular screening can cut breast cancer deaths by at least 30% - making women accept as gospel that having a mammogram annually will catch cancer early enough to be treated. |
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Recent research though by Danish cancer experts and the United States Department of Health and Human Services (DHHS) counter that the original studies were so flawed that there was no evidence that mammograms reduced the death toll. Confused? So are the cancer experts. The American Cancer Society (ACS) and the National Cancer Institute (NCI) are still maintaining that early detection as allowed by mammograms is still the best way to fight breast cancer. |
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“Regular mammograms do make a difference in preventing deaths from breast
cancer -- especially after seven years have passed,” describes Claudia
Henschke, MD, a professor of radiology at Cornell Medical Center in New
York, co-author of a study on this controversial topic. “There is a substantial reduction in the breast cancer death rates. The Danish (and other research) did not follow the outcomes of the women long enough,” continues Dr. Henschke adding that at the five-year results after mammograms, there were more deaths among the screened women than those used for comparison. At the sixth year, the numbers were equal in both groups. “But seven years after mammography began -- and up to the 11-year mark -- there were fewer deaths among screened women than the comparison group. “There is reliable evidence that, in women 55 years of age or older, mammographic screening is associated with reduced mortality from breast cancer," concludes Dr. Henschke. Like all medical research though, there is another side. “There are no definitive studies that really prove mammograms are beneficial,” counters Dr. Donald A. Berry, a member of the Physicians Data Query panel, is chairman of the department of biostatistics at M.D. Anderson Cancer Center in Houston. “The scientific evidence that mammography is beneficial is pretty weak. Women have been oversold on screenings because there's so much anxiety out there about breast cancer. “Our conclusions about the benefits of mammograms were based on the outcomes of seven studies that have been conducted around the world. We knew these studies weren't perfect but there was an article a few months ago in a scientific journal [the Lancet] which detailed some serious flaws in this research. Our subsequent review agreed with some of their critiques, and there was certainly a smoking gun or two, in terms of potential biases in these studies,” describes Dr. Berry. What biases? ”The first is the lead time bias. What that means is that you can detect an aggressive breast cancer earlier with a mammogram than you would by mere palpation. So instead of dying three years after being diagnosed, patients might live seven more years. But all you're really doing is moving the goal posts, and these women didn't survive longer than they would have without the mammogram. They were just diagnosed earlier. “The other key bias is length bias, which is more subtle. Mammograms tend to detect the smaller, slower-growing cancers that take longer to kill women. Or the tumor might have grown so slowly that they died of something else, and the cancer might not have been discovered otherwise,” points out Dr. Berry, adding that women need to think before getting a mammogram. “Women should find out about the uncertainties associated with mammography, such as the risks of false positives, and unnecessary surgery, as well as the inconvenience and expense of getting screened. They should balance this against the benefits, which are really quite modest even if you believe the test results at face value,” concludes Dr. Berry of advice countered by the ACS and NCI. Should you have a mammogram? The experts do not agree and there is an alternative to mammograms for most women – breast self examination -one of the easiest breast cancer exam methods. Here is how to perform one according to the ACS. Breast Self Exams (BSEs) should be performed once a month after your menstrual period, when breasts aren't tender or swollen. If you're not always regular, do it on the same day every month. If this is your first BSE, ask your health practitioner for detailed instructions and so that you can be sure that what you feel is normal and healthy. Don't get upset if you feel some lumps or hardness; that's natural. It is also normal if your breasts are not exactly the same size. Lie down with a pillow under your right shoulder and place your right arm behind your head. Place the finger pads of your three middle fingers on you left hand on the outer part of your bare right breast. Pressing gently but firmly, circle inwards until you have reached your nipple. You can also move up and down or in straight lines out from the nipple, but do it the same way each time. Gently squeeze the nipple and look for any discharge. Lower your right arm and switch, raising your left arm and examining your left breast with your right hand. Standing up in front of a mirror, check for changes in the way your breasts look. Look for dimpling of the skin, changes in the nipple, or redness or swelling. If you find any changes in your breasts, have pain in your breasts or are just worried about what you find in your breasts, contact your health care professional. But how effective are breast cancer self exams? "Unfortunately, mammography, which has been the gold standard for breast cancer screening for 50 years, is neither fail-safe nor risk-free. ”The fact is, most women detect their cancers themselves, in the shower or in the bedroom. Regular self-exams help women learn the landscapes of their own bodies so that they notice the slightest change. BSEs send women to the doctor, and thus help detect breast cancers that mammograms miss. "Until we develop a safe, foolproof and accessible screening method for breast cancer, self-exams are an irreplaceable element in the early detection tool kit,” describes Jeanne Rizzo, acting Executive Director of The Breast Cancer Fund. |
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