Mammography: What is Right for You?

By Mary Wilde, MD, Scripps Memorial Hospital La Jolla

The new guidelines for screening recently published by the government-appointed U.S. Preventive Services Task Force (USPSTF) are causing a great deal of confusion and concern — not only among my patients and countless other women, but also among physicians and other health care professionals who have long known that early detection is the key to successfully treating breast cancer and saving lives.

Curiously, the guidelines outlined by the task force are in sharp contrast to the gold-standard screening recommendations currently followed in the United States. And in many cases, they seem to contradict common sense.

For example, while the task force acknowledges that annual screening mammography decreases the death rate from breast cancer in 39 to 49-year-olds by 15 percent, they recommend against this routine screening because of the “anxiety,” “psychological harms,” and “inconvenience” it may cause, especially if the result shows a false positive (which is less than 6 percent of the time). Many women find it patronizing that the task force would suggest they can’t handle a little anxiety when it comes to taking care of their health. I believe the hundreds of strong, health-conscious women I know as patients, colleagues, family members and friends would agree that, yes, a positive mammogram can be distressing, but that in this case, ignorance is not bliss. The sooner breast cancer is detected and treated, the better the chance for a cure.

The task force also acknowledges that annual screening mammography in women ages 50 to 59 decreases mortality by 14 percent, yet then recommends doubling the time interval between screenings. (It makes no recommendations for women over 74 regarding screening mammography based on the stated fact that this age group has not been specifically studied.)

Further, it recommends that women not be encouraged to perform breast self-exams, nor should we have clinical breast examinations by a physician or nurse practitioner. Why would we ever discourage women from being aware of their own bodies?

This all leads one to wonder how, in the absence of screening mammography, clinical breast exam and breast self-exam, women are supposed to detect breast cancer in its earliest, most curable stages.

Moreover, breast cancer is not just an older woman’s disease; it is the leading cause of cancer death in women ages 15 to 54. More than 250,000 women living in the U.S. were diagnosed with breast cancer at the age of 40 or under, and approximately 10,000 young women will be diagnosed in the next year.

Breast self exams, clinical exams and screening mammograms are not perfect. However, they are the best tools we have to detect breast cancer in its early stages. Most women who develop breast cancer have no family history or other risk factors. Early detection through routine breast examinations and mammography is the best way to identify the disease when it is still treatable.

U.S. Health and Human Services Secretary Kathleen Sebelius issued the following statement in response to the USPSTF recommendations: “My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you.”

At at Scripps Memorial Hospital La Jolla, we agree. We continue to recommend a screening regimen as supported by the American Cancer Society and many other professional societies. This includes discussion with your own doctor or nurse practitioner, annual screening mammograms from age 40 onward, breast self-awareness, and annual clinical breast exams. If you have any questions or concerns, please don’t hesitate to discuss them with your health care provider and learn what is best for you.

Mary Wilde, MD, is the medical director of the Scripps Polster Center. “To Your Health” is brought to you by the physicians and health care professionals of Scripps Memorial Hospital La Jolla. For information or a referral to a Scripps physician, call 1-800-SCRIPPS.

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