Posted on: February 18, 2014
To Get a Mammogram or Not To Get a Mammogram: Risk Status Should Play a Role
By Philip C. Bonanno, MD, FACS, Director of The Breast Institute and Director of Integrated Cancer Care in the Cancer Treatment and Wellness Center at Northern Westchester Hospital
This news was hard to miss: A new study suggested that women who get annual mammograms are as likely to die from breast cancer as women who only get breast examinations from qualified doctors and nurses. If you find that news confusing, you’re not alone. Doctors, public health officials, and cancer specialists are all trying to figure out what the findings mean when it comes to detecting breast cancer and protecting women.
The study, published in the respected British Medical Journal, tracked more than 90,000 women for 25 years. The results found that death rates from breast cancer were identical in women who got mammograms and those who did not. Worse, in one in five cases, getting a mammogram often led to biopsies, radiation, and chemotherapy to treat cancers that actually posed no threat to the patient.
The point of the study was to determine whether there is a true advantage to detecting tumors that are too small to feel in a breast examination, and the answer was no. Part of the explanation for this finding is that many tiny cancers never become deadly, the researchers say. Also, breast cancer treatment has become far more effective, which makes early detection less critical when it comes to saving patients’ lives.
However, the study overlooks a crucial aspect of detection and prevention. The study really didn’t take individual risk into account. The research included all types of breast cancer, from relatively low-risk tumors to very invasive, aggressive cancer. When you look at women who are in higher risk groups, mammograms and other types of imaging tests can absolutely play a crucial role in saving lives, he explains.
I advise women to assess their risk status for breast cancer, i.e. family/genetic history, dense breast tissue, and lifestyle behaviors when making the decision to get a mammogram.
Lifestyle issues that can increase breast cancer risk include obesity, smoking, a history of hormone replacement therapy, prior irradiation to the chest for treatment of lymphoma, and being sedentary.
An individual’s family/genetic history of disease, belonging to certain ethnic groups, and dense breasts on mammographic studies are examples of factors that put women at higher risk. Women can sit down with certified genetic counselors and go over their family tree. If a close relative has died of breast cancer — or other types of cancer that may be related to breast cancer — women may wish to consult with their physicians to assess their risks, and may want to schedule a mammogram, an ultrasound mammogram, or an MRI to catch tumors before they can become deadly.
Editor’s Note: Northern Westchester Hospital offers Risk Analysis and Genetic Counseling with a Certified Genetic Counselor. Genetic counseling may be able to help you decide whether genetic testing is right for you. Schedule an appointment to learn more.