To mammogram or not

Women have been told for years to have an annual mammogram. But today, women may be receiving conflicting information. Some research says there is no advantage to the screening procedure and that it’s okay to allow the cancers to be found solely by palpation (feeling them). Other research shows a significant decrease in the risk of death from cancers by finding them at an earlier stage by mammography or other techniques. Statistics from the American Cancer Society may finally help put this question to rest. 

Over the past two decades, death rates from breast cancer have decreased by more than 30 percent from their peak in the early 1990s. The American Cancer Society contributes this statistical improvement to early detection. Other researchers contribute the decline to improved treatment, not early detection; thus, a controversy exists regarding screening. 

MammogramIt is now known that breast cancers are unique in that some cancers are significantly more aggressive than others. Some cancers are stimulated to grow by female hormones and others are not. Some tend to spread more rapidly than others: each cancer has a unique identity and requires a unique treatment. We now understand that a very small (less than 1/4 inch) aggressive cancer may have a worse prognosis than a large 1 to 2 inch tumor due to the unique characteristics of each tumor. Now we know that some early breast cancers are very slow growing and may never enlarge and spread beyond the breast and therefore, may never become life threatening to the woman who develops them; whereas some breast cancers may spread to other parts of the body before a woman or physician can even feel them during a physical exam. Screening tests cannot tell the difference between those two very different breast cancers. Mammograms could identify and possibly lead to over-treatment of some cancers so that we can prevent missing a life-threatening aggressive breast cancer.

Ultimately, the decision belongs to the woman.  The American Cancer Society, The American College of Surgeons, The American Society of Breast Surgeons and many others recommend annual screenings starting at age 40. When making the decision to screen, it helps to know what to expect.  When a mammogram is performed, one in 10 women will be called back for additional views or tests. Of those women, only one in 10 will require a biopsy. Biopsies are performed with a needle under a local anesthetic and leave only a tiny scar that does not deform the breast. Of all of the women who have biopsies, 80 percent will be benign and 20 percent will be malignant (cancerous). Overall, one to two breast cancers are found for every 1,000 mammograms performed. 

So, the question becomes: “To mammogram or not to mammogram?” What should a woman do? Keep three facts in mind when making this important decision. First, breast self-exams and physician exams are not particularly accurate; breast cancers can easily be missed until they become very large. This is especially true if the cancer is softer and deep within the breast tissue. Second, if your cancer is caught at a smaller size, there is a better chance your breast may be preserved, and there is a better chance you can avoid potentially toxic chemotherapy. And most importantly, no matter what the biology of the cancer is, the prognosis will ALWAYS be better when caught at a smaller size before spreading to the lymph nodes.

About Patty Tenofsky, MD, FACS

I am a breast care specialist with Via Christi Clinic at Founders' Circle in Wichita, Kan.
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