Health & Fitness

Doc Talk: Why women may want to consider a mammogram

Women are given conflicting information about mammography.

Some articles and research say that there is no advantage to the screening procedure and that it is OK to allow the cancers to be found by palpation (feeling them). Other research says there is a significant decrease in the risk of death from cancers by finding them at an earlier stage. Statistics coming from the American Cancer Society may finally help put this question to rest.

During 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 attribute this to improved treatment and not early detection, and thus a controversy exists regarding screening.

It now is known that breast cancers are unique in that some cancers are much more aggressive than others. Some 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 is treated in a unique way. We now understand that a very small (less than a quarter of an inch) aggressive cancer may have a worse prognosis than a large one- to two-inch tumor because of the biology of these tumors. We also know that some early breast cancers are very slow-growing and may never enlarge and spread out of the breast and therefore may never become life-threatening.

But some breast cancers may spread to other parts of the body before a woman or physician can even feel them on 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 is up to the woman. The American Cancer Society, the American College of Surgeons, the American Society of Breast Surgeons and many others recommend screening starting at age 40.

When making the decision to screen, it may help to know what to expect. When a mammogram is done, 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 done 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 is: To mammogram or not to mammogram? What should a woman do?

Keep three facts in mind when making that decision: First, breast self-exams and physician exams are not particularly accurate, and breast cancers easily can be missed until they become very large. This especially is 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. Third, and most importantly, no matter what the biology of the cancer is, the prognosis always will be better if it is caught at a smaller size and before it can spread to the lymph nodes.