Breast Cancer in the News: Is Breast Cancer Screening Worthwhile?
Within the last few weeks, the U.S. Preventive Service Task Force, a government-backed panel of doctors, published guidelines advising that women who aren’t at high risk for breast cancer shouldn’t begin having mammograms until age 50, and should have them only every two years, because the benefits of mammograms in younger women aren’t worth the potential risks from false positives and unnecessary radiation. This pronouncement, along with similar recent statements about the efficacy of breast cancer screening, has proven extremely controversial, both in the medical community and among women in general.
Even though the American Cancer Society is not changing its breast cancer screening recommendations, which call for yearly mammograms in women over 40, all these reports and articles are understandably causing confusion. How is the average woman supposed to make sense of whether and when to get a mammogram? We asked several members of our Medical Advisory team that question. Here’s what they have to say.
Dr. Susan Boolbol, Beth Israel Medical Center
Although mammography may result in some benign breast biopsies, it remains the best screening test for the early diagnosis of breast cancer.
Dr. Alison Estabrook, St. Luke’s Roosevelt Hospital Center
I agree that it is too early to change recommendations. It would be nice if we could tailor our screening recommendations by risk category, and it would be great if we had a better method of detection, but we have neither right now.
Dr. Daniel Fass, Institute for Image-Guided RadioTherapy
I agree that it is too early to change recommendations. It would be nice if we could tailor our screening recommendations by risk category, and it would be great if we had a better method of detection, but we have neither right now.
Dr. Daniel Fass, Institute for Image-Guided RadioTherapy
I totally agree with the recommendation to continue screening mammograms. Even the study’s lead author backtracked and said that women 40 to 50 should discuss mammograms with their physicians as opposed to not having them. The breast cancer death rate in that age group has fallen 3% per year since 1990, and mammograms are partially responsible.
Dr. Steve Lo, Bennett Cancer Center, Stamford
It is very important to emphasize that screening with mammograms still saves lives, and that all women over age 40 should continue to have annual screening mammograms. The problem is that the medical world is not yet smart enough to select who will really benefit from screening, and what cancers caught by screening do and don’t need to be treated. Future research looking at molecular signatures and genetic risks will hopefully allow us to individualize the screening and treatment process.
Dr. Donna-Marie Manasseh, Women’s Breast Center, Stamford Hospital - Tully Health Center
I am concerned that the message will be misinterpreted by the public as “mammograms are unnecessary.” They may miss some cancers and may have false positives, but mammograms are one of the few tools we have to aid in the detection of breast cancer. The hope is that with continued research women will have a biopsy and through some form of genetic analysis we will be able to determine which surgical, radiation and medical therapy will be best for her tumor. But we still need to find the tumor early and right now mammography is the tool we have.
Dr. David Rimm, Yale University School of Medicine
This is big news, but don’t interpret as a reason to stop getting mammograms! We now recognize the importance of understanding the biology of the disease rather than simply measuring how big it is. This means we need new tests for molecular characterization of the tumors and better use of the tests we have. We must also improve screening or use it in targeted populations. Screening works well when it finds precancer, as in the Pap Smear or the colonoscopy, but not as well when it finds cancer (Mammograms and PSA). Thus new tests are needed that find propensity for cancer (high risk populations) or can find precancerous lesions.
