Mammogram Controversies

There has been a lot in the press lately about the utility and effectiveness of various types of screening tests for common cancers.  This is not all bad news however, because some forms of cancer screening actually endanger patients, to the tune of millions of dollars annually.

Check out this discussion about breast cancer screening changes. Will the result by more cancer deaths, or not?

The bigger issue is patient empowerment and patient education.  If a woman understands the purpose and limitations of any given screening test, she will engage with it more appropriately, which saves the system gobs of money, and even more important, makes for a healthier population.  On the mammogram issue, annual screenings in a woman’s 40s have always been controversial, so that part of the new guidelines is actually old news.  Baseline mammography should occur by age 40, or sooner if a woman has a strong family history for breast cancer.  However, annual mammogram screenings in women in their 40s is a bad idea.   After that baseline ladies, wait until you are in your 50s unless something changes such as initiating a hormone prescription (especially the non bio-identical variety such as Premarin) or feeling an asymmetrical lump in your breast tissue.

The most shocking part of the new guidelines is the notion that breast self-exams are useless.  They are not useless. Most breast cancer survivors discover the cancerous lump themselves.  Please check elsewhere on this site for the description of a technique called Better Breast Self-Exam.

The idea that cancer screens prevent cancer is an unfortunate misconception to which the cancer industry does not strenuously object, but this is hardy surprising since the medical machine partly works by selling drugs and fear.  Breast self-exam is the ultimate tool for early detection.   It is completely patronizing to suggest that BSE is ineffective.

Annual mammography as an industry strategy has done nothing to reduce breast cancer mortality since it was widely deployed in the late 1980s.   The only change which has put a dent in breast cancer deaths since the advent of the annual mammogram has been the reduction of prescription hormone use.  In the summer of 2004, findings from the 200,000-women-strong study called the WHI (Women’s Health Initiative) were published linking the use of conventional hormone replacement therapy (like Premarin or, more dangerous PremPro) to increased rates of breast, colon and uterine cancers.  These increases were not huge, but considered statistically significant.  Many women have abandoned these post-menopausal drugs and doctors are much more cautious about prescribing them.

If you must take hormone support for intractable hot flashes or rapid bone loss that cannot be resolved any other way, use only bio-identical hormones (which are prepared by compounding pharmacists and mimic the exact molecular construction of naturally occurring progesterone and estrogen and testosterone molecules).

Dr Emily A Kane is the author of Managing Menopause Naturally

Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Blez M, et al.  Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer.  JAMA. 2008  May 14;299(18):2151-63.