Are mammograms safe?
We look at the recent controversies surrounding mammograms.
Recently released guidelines from the United States Preventive Services Task Force, an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services, raised some controversy around mammograms. Dr Sarah Rayne, Specialist Surgeon at Netcare Breast Care Centre at Milpark Hospital, Johannesburg, gives her opinion
There are conflicting recommendations about mammographic screening. The US task force on preventative medicine put the cat among the pigeons in 2009 by reversing the recommendation of starting mammograms regularly at 40 (baseline 35-40). This is because of a number of factors: Health economics say that you will benefit 1 in 2 000 women between 40-50 with a screen, whereas you benefit 1 in 1 400 women from 50-59. So it depends whether you are the one women who benefits, or the company paying for the other 1 999 mammograms, as to what your belief is. This has to be tempered with the knowledge that many of the 1 999 women may go through anxiety associated with considering a possible diagnosis and further biopsies that turn out to be negative. On the balance of all these things, we continue to recommend baseline after 35 and annual after 40 because we believe, in line with the American Cancer Society, that the risks are outweighed by the benefits. The more people get used to the concept of screening, the less they will fear the test.
There are conflicting recommendations about self-breast exams. The same task force withdraws recommendation for breast self-examination in the same document, and it is important to take these two recommendations together and in context. In the USA, 70-80% of the population are screened, so a breast exam may increase fear and false negatives. In our population, who know much less in general about breasts, a breast self-exam positively reinforces breast awareness and allows women to pick up lumps early. In the USA they would be detected by screening before a lump even develops. Breast self-exam reminds a woman to go for screening and, as such, is a very useful tool we thoroughly recommend.
Mammograms do not significantly increase your risk of breast cancer. In a small subset of women, who have a high risk of breast cancer and had mammograms from the age of 20, there was an increased risk associated. In these women, however, yearly mammograms are certainly not the best option and there is good data to suggest sonar is as effective and, certainly, MRI should be considered, along with close specialist follow-up. It is these types of unhelpful blanket statements that muddy the water and confuse women, which is why a local, sensible and united policy is important.
We don’t live in the USA, and much of their data does not apply to us. We do not know what the lifetime risk of breast cancer is in South African women, but we do seem to see younger women and more aggressive subtypes, which means we have to tailor international guidelines to our own local situation. Regular mammograms, as recommended by ACS are important, and if we apply to the tightest guidelines, we ensure that even if women fall through the gaps and occasionally miss a year, they will still be screened to the minimum expected guidelines. And for us, breast awareness and breast self-examination keep a women reminded to focus on breast health, and allows us to educate and screen populations otherwise missed by mammography.
To read the full version of this story go to page 132 of the April issue of DESTINY