(The piece below is second in a series of responses by WVFC’s Medical Advisory Board to the new screening guidelines for breast and cervical cancer issued last week. Check back later for word from Dr. Elizabeth Poynor on cervical cancer screening and from Dr. Allen on the cumulative effect of both. — Ed.)

Breast cancer is every woman’s greatest fear.  I don’t know one woman who enjoys getting the “dreaded” mammogram. But the recommended guidelines proposed by the USPSTF have clearly sent out the wrong message.

As a medical oncologist who treats breast cancer and as a woman, I was distressed by the recent recommended screening guidelines by the U.S. Preventive Services Task Force (USPSTF).  Early detection remains a woman’s best defense against breast cancer. Although mammography is not perfect, it is the best tool doctors have to screen for breast cancer, and often detects a tumor that is too small to be felt. Sometimes,  mammograms may miss a cancer, or suggest that a further testing is necessary and the mammogram turns out to have been an imperfect screening tool.

Despite these imperfections, the best scientific evidence shows that regular mammograms help lower the risk of a woman dying from breast cancer. The task force did acknowledge life-saving benefits of mammography in all women over 40- 49, though the benefit was smaller among younger women, 15 percent, vs 30 percent in women over 50. The benefit for younger women, however, is still real.

All women aged 40 and older should discuss their individual risks and benefits from mammography, and decide upon an appropriate screening schedule. Women who are at high risk should have this discussion at a younger age. The proposed guideline changes would mean that many breast cancers would be diagnosed at a later stage, making it harder for the patient to become cancer-free.

The physical, emotional and financial costs to make disease free survival a real possibility increase as tumors grow larger and the likelihood of tumor spread to local lymph nodes and other organs also increases. Detection at a later stage results in more women with large or multiple cancers requiring mastectomy, eliminating the option of lumpectomy or breast-conserving surgery. Later-stage diagnoses result in more women with metastatic disease (cancer that has spread to other parts of the body beyond the breast and axillary, or armpit, lymph nodes) and is rarely curable. In younger women, breast cancer tends to be more aggressive, so early diagnosis and treatment is even more important.

Ne wer digital mammography has been shown to be superior to older film technology for women with dense breasts ( more common in younger women). This issue was not and could not be addressed by the USPSTF.  Historically, clinical trials have been ageist and not included many women over 70 years, so the data is absent on such women. Yes, breast cancer might grow more slowly in this group, but it will still cause the death of the women who are not treated. Remember: age is one of the most significant risk factors for developing breast cancer.  The proposed changes would mean that both younger and older women would be diagnosed later.

The death rates for breast cancer as reported by the American Cancer Society have continued to decrease annually for nearly 20 years, due to both early detection and early treatment. It would be devastating to reverse the gains that have been made. And I am concerned that some women will forgo regular screening  and that access to screening mammography may  be denied for others. Already, more than 30 percent of women do not get screened regularly.

Regarding the “trauma” of undergoing a breast biopsy for a “false positive” mammogram: I have yet to meet a woman who is angry that she underwent this only to find out she did not have cancer.  Relief and joy is the typical response. It has been very difficult to prove the merits of breast self examination in a scientific manner.

It is plain common sense that being aware of your own body, and seeking appropriate medical attention sooner than waiting for a regularly scheduled examination, will increase the detection of cancers at an earlier more curable stage and require less treatment.  Yes, some cancers may be more “indolent’ or slower-growing, but at the present time we have no way of knowing that without surgically removing these cancers.  We have made improvements in our ability to diagnose the aggressive nature of cancer cells but only after removal of the malignant tissue.

Unfortunately, there is no crystal ball that can replace mammography.

Bonnie S. Reichman, MD, F.A.C.P., is a Clinical Associate Professor of Medicine at the Weill Medical College of Cornell University; and an attending medical oncologist at The New York Presbyterian Hospital. Dr. Reichman is especially interested in the issues confronting women who are diagnosed with breast cancer and has built her practice to meet the medical, psychosocial, and educational needs of this unique patient population and their families. Dr. Reichman is, is a past President of the New York Metropolitan Breast Cancer Group, Inc.. She serves on the Executive committee of the New York State Society of Oncologist and Hematologists, Inc., and is on the Medical Advisory Board of New York Komen for the Cure, and is on the membership committee of the American Society of Breast Diseases. She was a member of the Board of SHARE, and was on the Board of Directors of the National Alliance of Breast Cancer Organization (NABCO). SHARE. She is a recipient of the Gay Clark Stoddard Memorial Award from the NYC affiliate of Komen for the Cure.

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  • Laura September 27, 2010 at 1:35 am

    Indulge me a moment while I explain that I’m writing due to a tv program today showing the latest progress we’ve made sending probes into space, flying with new long term fuel and at much higher speeds. This while I wrestle with a mammo tomorrow or cancel it because the technician severely hurt me last time. At 66, I’ve had many of these and frankly am sick of this painful procedure as a test. Science can take us to other worlds but can’t improve this test to one that is humane?? I can’t help but think if men were receiving this test, it would have been improved years ago!