A new study published by the New England Journal of Medicine last week questions the value of mammograms for breast cancer screening, but health officials and breast cancer survivors in Johnson County disagree.
The study concludes that a woman is more likely to be diagnosed with a small tumor that is not destined to grow, causing them to get treatments they don’t really need.
Researchers used decades of federal surveys on mammography and cancer registry statistics to track how many cancers were found when small — under 2 centimeters, or about three-fourths of an inch — versus large, when they are presumably more life-threatening.
They estimated death rates according to the size of tumors for two periods — 1975-79, before mammograms were widely used, and a more recent period, 2000-02.
In the earlier period, one-third of cancers found were small. In the later period, two-thirds were small.
But the change was mostly because screening led to many more cancers being detected overall, and the vast majority of them were small — 162 more cases per 100,000 women, versus only 30 more cases of large tumors.
Assuming that the true number of cases of cancer in the population was stable, this implies that 132 cases per 100,000 women were overdiagnosed.
Next, they estimated how much of the drop in deaths since mammography started was because of early detection versus better ways to treat the disease. They concluded that at least two-thirds of the drop was because of better treatments — a trend other studies also have found.
“Whether to have a mammogram is a close call, a value judgment,” study leader Dr. H. Gilbert Welch of Dartmouth Medical School said. “This is a choice and it’s really important that women understand both sides of the story, the benefits and harms.”
Those who oppose the study
Jessica Hals, medical oncologist for Texas Oncology, argues that tumors have to be found before they can be treated, and so far mammography is the best way to find ones that can’t be felt.
“While breast cancer cannot be completely prevented, women can take steps to decrease their risk,” she said. “There has been controversy about optimal screening schedules in the last decade, causing confusion for patients. Early diagnosis of breast cancer increases the likelihood of effective treatment, and mammography is the most effective way to screen for breast cancers that cannot be felt during a self or clinical breast exam.”
Hals said understanding the signs and symptoms of breast cancer is also critical to detecting cancer earlier.
“Symptoms can include a lump in the breast, change in breast size or shape, dimpled skin near the breast, pain in the breast or nipple, as well as others,” she said. “The signs of breast cancer are not the same for all women, and general screening recommendations are for women with average risk.
Mammograms help lead to early detection, which can help save lives. Women diagnosed with breast cancer that has not spread outside the breast have a higher survival rate.”
Women in their 60s get the most benefit from mammograms, according to the American Cancer Society. A government task force also recommends screening every other year starting at age 50, and that women in their 40s weigh the pros and cons.
Quiva Hays, 81, of Cleburne was first diagnosed with breast cancer in 1993 after she discovered a small lump in her breast while doing a self-exam.
“I went in for a mammogram and they found it and it was cancer,” she said. “Every day that I’m in remission I thank God for it.”
Hays said it is a must for women to get mammograms, despite what the study suggests.
“If you catch breast cancer early, you are so much better off,” she said. “Some women don’t want to hear the news that they have cancer, but I didn’t either. If you can detect it early, maybe the treatments won’t be as bad.”
More and more teenagers, Hays said, are being diagnosed with breast cancer every day.
“Early detection saves lives and you just need to get yearly checkups,” she said. “I don’t like to do it, but I have to do it.”
Texas Health Harris Methodist Hospital Cleburne offers 3-D mammography services which may help detect cancers earlier and more effectively than a traditional mammogram.
With 3-D mammography, image “slices” of the breast are taken from multiple angles and then used to create a 2-D image of the breast. The resulting images allow your radiologist to view breast tissue layer by layer.
Benefits of 3-D mammography include:
- Improves radiologists’ ability to screen for and detect potential breast cancers.
- Helps radiologists pinpoint the size, shape and location of abnormalities
- Can help distinguish harmless abnormalities from real tumors, leading to fewer callbacks and less anxiety for women.
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