Brenda got the call every woman dreads: “There is an area of concern on your mammogram and we need to take a closer look.”
Fortunately, most abnormalities on screening mammograms are false alarms. More than half of women who undergo annual screening for 10 years will have at least one false positive result. Radiologists would rather err on the side of caution than to miss tumors. Unfortunately, the false alarms can have detrimental unintended consequences. Many women who get the call-back experience days or weeks of panic and fear: of death, disfigurement from surgery, and suffering from radiation and chemotherapy. Others, mostly those with dense breasts, tire of getting called back so many times that they give up on mammograms altogether, a result demonstrated by a recent very large study.
Your risk of a false positive test is higher than average if you: undergo screening every year instead of every other year; have dense breasts; are under 50; take hormone replacement; have had a breast biopsy; or have a family history of breast cancer. This is problematic because some organizations are recommending women undergo screening earlier in life and repeat it annually.
Unfortunately for Brenda, she was found to have cancer. When she first came to the office for assistance, I asked how long it had been since her previous mammogram. It had only been a year, and it was normal at that time, other than her usual “heterogeneously dense breasts.” Looking at the x-rays that picked up the tumor and the films from the previous year, it was obvious that the tumor was not new. It stuck out like a sore thumb. Granted, I had the advantage of hindsight, as well as the more recent films for comparison.
This illustrates another significant problem with the technology we have all come to depend so heavily upon for breast cancer screening: In addition to its high false positive rate, it has an elevated false negative rate in women with dense breasts. This is because tumors have the same density as fibroglandular tissue, which is in varying degrees in more than half the female population.
For this reason, 40 states already require mammogram providers to inform women when they have dense breasts. This enables these women to consider alternative means of screening for abnormalities, including thermography, ultrasound, and MRI. Even the FDA is now on board with the decades-old science and made notification of all women a requirement effective September 10 of this year. This is a late but huge step in the right direction.
Fortunately, you don’t need a mammogram to tell you that you have dense breasts. Any well-trained physician can tell you as much during your annual examination simply by identifying the presence of fibrocysts in your breasts. If this is the case, you might consider sparing yourself the unnecessary radiation and talking to your doctor about undergoing other means of early cancer detection.
Taking this a step further, if I was a woman, I would want to know about the study published in 2011 in the journal Radiology entitled “Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades.” In this study, 519 women had to undergo screening mammograms for 7 years to prevent 1 death from breast cancer. A separate study published in the New England Journal of Medicine in 2010 found that 2,500 women had to undergo annual mammography for 10 years to prevent 1 breast cancer death. A 2014 Canadian study of 90,000 women followed for 25 years found that the death rate from breast cancer was the same whether a woman underwent annual mammography or saw her doctor for an annual breast exam.
Regardless of the exact number, the bottom line is that it takes a lot of mammograms to save one life, and an annual breast exam by a competent doctor is just as effective at preventing breast cancer death as an annual x-ray. The evidence is so strong that in 2015, Dr. Eric Topol of the Scripps Institute announced, “All of the data now available point to significant net harm – far more risk than benefit – for routine mammography. If this were a drug, the US Food & Drug Administration (FDA) would never approve it. Last year, the Swiss Medical Board, after reviewing all the data, recommended abolishing mammography.”
All of this is not to say that mammography is not a valuable tool. It merely demonstrates that it should be reserved for diagnosis—when an examination or another screening method identifies an abnormality—instead of being used indiscriminately for screening women without any concerns. The problem we currently face is that the practice of medicine remains, on average, 17 years behind the science of medicine, according to the National Library of Medicine. Part of this stems from doctors simply not having the time to read and evaluate published medical studies.
Another part stems from human nature: Like everyone else, doctors don’t like to discover we were wrong, so we doggedly cling to what we were taught before new evidence came out. We have all heard the slogan “Mammograms Save Lives” so many times over so many decades that it can’t possibly be wrong, no matter what the evidence shows.
If you choose to follow the science and forego annual screening mammography, however, you might be inclined to panic. Even though far more women die of heart disease, for some reason most women perceive their risk of dying from breast cancer to be their biggest health threat. Fortunately, you are not without options. In addition to annual breast exam, you and your doctor may consider other modalities—such as thermography, ultrasound, MRI, or liquid biopsy—as part of a personalized strategy that makes the most sense for your circumstances.
To be sure, no single tool will pick up every tumor. This is why it is important to utilize tools in combination. Moreover, because tumors are not large enough to be detectable by mammography, ultrasound, or MRI until they have been growing for a minimum of 8-10 years, an ideal breast health plan focuses on preventing, reducing, or even eliminating as many of the known contributors to breast cancer as possible.
Scientists have uncovered much in terms of the drivers of breast cancer, but the overwhelming majority of physicians in practice have never even heard of most of them. This is why doctors settle for “early detection” instead of trying to prevent breast cancer. But finding a tumor after 10 years of growth can hardly be called early detection, unless we redefine “early” as “before a woman would discover it herself.” However, as noted above, your risk of death is no greater if your tumor is discovered on exam than by mammogram.
When it comes to screening for breast cancer—or any cancer—there are no easy answers. Doctors who make sweeping one-size-fits-all recommendations lose credibility when the actual science proves them wrong. In the absence of clear-cut data, doctors need to use what data we do have to help women make screening decisions that make the most sense for their individual circumstances. Like many women today, Brenda did not have to catch her cancer so late that her breast had to be removed…and neither do you. If you are looking for a more proactive and customized approach and value being in charge of your own breasts, go to www.prestigewellnessinstitute.com to schedule a consultation.