From the Executive Director: Does Mammography Screening Save Lives?

Barbara Brenner

by Barbara A. Brenner

Debates about who should have screening mammograms—those given to women with no breast symptoms—and when are not new to longtime followers of BCA’s work. Our position has long been clear: women who are premenopausal should not have regular screening mammograms, and everyone should know the risks associated with all screening methods (mammograms, breast self-exam, clinical breast exam) and make the best decisions for themselves.

Interestingly, emerging science and revised recommendations on screening are now confirming what BCA has long said about these matters. One of the leading health policy organizations—the U.S. Preventive Services Task Force (USPSTF)—has issued new screening recommendations for women who are asymptomatic and who are not at elevated risk of breast cancer.

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Our position has long been clear: Women who are premenopausal should not have regular screening mammograms, and everyone should know the risks associated with all screening methods (mammograms, breast self-exam, clinical breast exam) and mkae the best decisions for themselves.

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In addition to calling for an end to routine mammography screening for women 40 to 49, the USPSTF is encouraging a shift away from annual mammograms for postmenopausal women, and toward biannual (every two years) screening. This recommendation is consistent with the practice in most other countries with screening programs, and those countries have no worse outcomes in terms of breast cancer mortality than the United States.

But as we know from long experience of bucking the trends in breast cancer policy, many people are upset and/or confused by these new recommendations.

Some people are upset because their breast cancer was found on a mammogram that they wouldn’t have received under the new guidelines. Some people are confused because they don’t understand what the downsides could possibly be to the early detection of breast cancer.

It’s very difficult for people to ignore their personal situations in thinking about what should happen as a matter of policy. But emerging science tells us that we need to try to do that if we’re going to get to the best place in terms of both reducing deaths from breast cancer and minimizing the harms that occur when we do mammography screening.

One thing to keep in mind is that mammograms are a medical intervention, and like all medical interventions, they have benefits and risks. The benefits have to do with finding some cancers early enough to effectively treat them so that fewer women die of breast cancer. The risks are these:

  • False negative results (mammogram reads as clear, but breast cancer is present).
  • False positive results (mammogram shows a problem, but biopsy reveals that the problem is not cancer). False positive results result in unnecessary biopsies, increased anxiety and stress, and physical scarring.
  • Cumulative exposure to radiation. (Radiation is one of the few known causes of breast cancer. All radiation exposures accumulate in the body. Our bodies do not eliminate these exposures.
  • Diagnosis and treatment of cancers that are not life threatening at the time of diagnosis and will never become life threatening if untreated.

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    These risks can and should be balanced against the benefit of finding a breast cancer early enough to effectively treat the disease and reduce the number of women who die of breast cancer.

    What is not well understood is that “early detection” doesn’t really mean what we’ve been lead to believe, which is that finding breast cancer early is the key to survival. It’s not that simple.

    BCA’s current screening policy explains the limits of breast cancer “early detection.” Briefly, the complex biology of breast cancer means that women diagnosed with “early” breast cancer fall into one of the following three groups related to the biology of cancer:

    1. Those that have a type of breast cancer that responds to currently available treatments
    2. Those that have a type of breast cancer that is not and will never become life threatening
    3. Those that have very aggressive disease that cannot be effectively treated with currently available therapies

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    While we don’t know how big these groups are, we do know that the only people who actually benefit from early detection are those in the first group. These women’s lives can be saved by early detection if they get the appropriate treatment in a timely manner. These are the women who need screening.

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    We have suffered from oversimplification of the breast cancer early detection message for far too long. The new recommendations on screening may help us move to a more nuanced understanding of breast cancer and, ultimately, to a better place for all of us.

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    We have suffered from oversimplification of the breast cancer early detection message for far too long. The new recommendations on screening may help us move to a more nuanced understanding of breast cancer and, ultimately, to a better place for all of us.

    So, don’t throw up your hands. Contact BCA if you have questions, and make the best decision for yourself. You know that BCA will always give you the straight story. We can keep doing that with your help. As 2009 winds to a close, please consider a generous gift to keep BCA in the forefront of breast cancer issues. And please share this story with three of your friends.

    Together, we create a better world.

    This entry was posted in Articles.