Thursday, November 19, 2009

Surgeon Responds to Mammogram Controversy

by Holly Hosler


By now, you have likely heard about the U.S. Preventive Services Task Force’s controversial new recommendation on Monday that most women should refrain from getting mammograms in their 40s. Their rationale is that most breast cancer is found in women after age 50, and that mammography spots too many false positives for women in their 40s.


So when should women get their first mammograms? Dawn Leonard, M.D., breast surgeon and medical director of Northwest Hospital’s Herman & Walter Samuelson Breast Care Center, says that current standards as outlined by organizations such as the American Cancer Society and the National Comprehensive Cancer Network should still be followed. Annual mammograms, in conjunction with annual clinical breast examination should begin for women starting at age 40 – and perhaps even earlier if a woman has a strong family history of breast cancer.


“When a woman has a family history of the disease, she should get her first mammogram 5 to 10 years before the earliest age of breast cancer diagnosis among her relatives,” says Dr. Leonard.

She also points out that even with advances in breast cancer diagnosis and treatment, there are still populations that are more vulnerable with higher breast cancer mortality rates. For example, breast cancer tends to strike African American women at a younger age than is often expected by the medical community, and their mortality rates are higher.


“Practice guidelines that post-pone mammographic screening and eradicate self and clinical examinations will have detrimental impacts on early diagnosis and cancer survival. The medical community and the advocacy community have worked tirelessly since the ’70s to empower women to be more aware of their breast health needs and to make choices that improve breast cancer survival. The recent USPSTF recommendations appear to be a step in the wrong direction,” concludes Dr. Leonard.


The American Cancer Society stands by its guideline that by age 40, all women should be getting an annual mammogram. This group also recommends that each woman get a baseline mammography between the ages of 35 and 40 so that doctors have a record of what is likely “normal” for her. Our bodies are all different, so if you are a woman aged 20 and older, it is important to do a self breast exam on a monthly basis. This way, you know what is normal for your own breasts, and when you feel something out of the ordinary, you can alert your physician. For directions on how to perform a breast self exam, visit the American Cancer Society.


Finally, the task force also made the statement that breast self exams are of no value. However the fact remains that, though at a much lower rate, breast cancer occurs among young women as well. I know of at least two women, without family histories of breast cancer, who were diagnosed with breast cancer before age 40. Had it not been for breast self exams, these women would not be with us today.


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