Hiya Pinkies. I already posted something for today, but a bunch of you have come to me begging me to don my white coat and comment on the new recommendations from the U.S. Preventative Task Force about mammography in young women, so here goes.
Mammograms – Not Perfect, But Far From Pointless
My father was a radiology doctor who specialized in mammograms, so I grew up around those machines that take two perfectly good knockers and squash them into Swedish pancakes. Dad used to joke that if women were in charge of medicine, men would have to stick their penises between two plates and get “manograms” after the age of 40. When I was young, I remember sitting beside Dad in the dark screening rooms while he inspected film after film, hunting for subtle signs that might signal breast cancer. He likened it to reading a Where’s Waldo book. Mammograms may seem like torture, but they also may save your life.
But we all know that. Why am I writing this post? Because the U.S. Preventative Task Force just declared that women in their 40s of “normal risk” should no longer get routine mammograms. They also say women after 50 should only get mammograms every other year, recommend against teaching breast self-exams for all women, and say no mammograms after the age of 74. WTF? What changed since they recommended mammograms every 1-2 years in women over 40?
Okay, so mammograms are far from perfect. So we’re gonna throw all progress we’ve made in reducing breast cancer mortality out the window? What about new advances in digital mammography? What about my patient who just potentially saved her own life by finding a breast cancer while examining her breasts? What about Mrs. Olivier, my amazingly vital 81 year old patient whose mammogram found an early breast cancer ten years ago and is still alive and kicking after treatment?
Okay. So it’s true. Self breast exam data isn’t stellar. Large studies have shown it to be pretty ineffective, actually. But what about those few women who do detect their own cancers and save their own lives? Plus, what’s the harm in feeling your boobies for lumps? And what’s with the recommendation against mammogram in women after 74? These are the women at highest risk, for whom mammography screens most effectively. All of the sudden, Grandma is no longer important? Have I just stepped into some alternate universe? I mean, seriously, people.
Why Did They Change The Guidelines?
There is no new data. It’s all about how you look at the existing data. The Mautner Project summarizes the data:
The USPSTF used statistical modeling to predict the impact of screenings found over a 10 year period. It found that if a thousand women beginning at age 40 were screened with mammograms, there were small gains in cancer deaths averted, compared to if these women started at age 50. Specifically, their modeling found that 6.1 deaths would be averted, compared to 5.4. The panel judged that difference to be not worth the expense, biopsies and anxieties.
The woman whose life was saved might beg to differ.
Let’s look at those numbers in terms of larger numbers of women screened, using the statistical modeling provided by the USPSTF:
Deaths of women averted by screening in their 40s vs. deaths of women averted by women who start screening in their 50s:
1,000 women 6.1 5.4
10,000 women 61 54
100,000 women 610 540
1,000,000 women 6100 5400
So for every 100,000 women screened in their 40s, as opposed to waiting till their 50s, 70 more women would live. For every one million women, 700 more women would live. Over 33 million mammograms are performed each year in the United States.
The New York Times of 11/18/09 reported that the USPSTF also found differences in years of life gained by women receiving mammograms in their 40s, compared to starting mammograms at age 50:
Years of life gained per
1,000 women 120 99
10,000 women 1200 990
100,000 women 12,000 9,990
1,000,000 women 120,000 99,990
Gulp. Personally, I don’t need some patronizing government board trying to protect me from anxiety. I’d rather be protected from breast cancer, thank you very much.
What the Studies Say
Whew…Deep breath, Dr. Lissa. Okay, so mammography for women in their 40s has long been a controversial issue. Truth is, mammography just isn’t a great screening tool for women age 40-49. In our forties, our breasts are more dense, making it harder for X-rays to penetrate breast tissue to see early signs of cancer. Also, because breast cancer is less common in this population, you’re more likely to wind up with false positives, leading to follow up mammograms, breast biopsy surgeries, and enough anxiety to leave you quivering. So medical societies have been mixed on their recommendations for women in their forties, but most agree that women in their forties should have mammograms no less than every other year.
While they’re not an ideal screening tool for breast cancer, studies estimate that mammograms detect about 75% of breast cancers in women in their 40s and 90% percent of breast cancers in women in their 50s and 60s.[i] Early detection can mean the difference between living and dying. If you’re over 40 and you get mammograms regularly, your risk of dying of breast cancer is reduced by 34%.[ii]
So why the push to nix it altogether when we already know that mammograms save lives? According to Dr. Otis Brawley, chief medical officer for the American Cancer Society, “With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.” Say what? Actually, I do hear what they’re saying. The task force isn’t saying that nobody should get screened in their 40s. They’re saying they should talk to their doctor about risk, but they shouldn’t get screened routinely. And I hear what they’re saying from an epidemiological standpoint. So maybe it’s not cost-effective. But price can you put on a mother of two young kids? I know we docs aren’t supposed to, but I can’t help getting emotional about this. I’ve lost too many people to breast cancer already…
Others Disagree
The American Society of Breast Surgeons just issued this statement. “We believe there is sufficient data to support annual mammography screening for women age 40 and older. We also believe the breast cancer survival rate of women between 40 and 50 will improve from the increased use of digital mammographic screening…The Society will continue to advocate for routine annual mammographic screening for all women beginning at age 40. Mammography screening reduces breast cancer mortality and saves lives.” The American Cancer Society and the American College of Obstetricians and Gynecologists agree.
On the flip side, Dr. Susan Love, author of Dr. Susan Love’s Breast Book agrees with the new task force recommendations. She says:
These recommendations are long overdue. Most countries do no support mammography screening under 50 and do it every other year after 50 in their government-sponsored screening programs. I hope that the insurers will change reimbursement, because it is probably the only way that women will be spared the extra radiation exposure of too many mammograms. Since our system pays the radiologist, hospital, or mammography center and biopsying surgeon by the more they do, there is no incentive for this to come from the medical profession.
Strong words. Yes. Mammograms have their risks. Applying radiation to a breast in order to reduce the risk of breast cancer may indeed seem counterintuitive. I work at a holistic health center, and many in the holistic health world recommend against mammography altogether, favoring breast thermography, which my patients often choose to use as an alternative to mammography. And yes, it’s true that mammography is not a great screening tool for younger women. But what’s a girl to do?
So what do I think?
Well, I’m admittedly biased. Half a dozen of my closest friends and many of the women I’ve worked with for The Woman Inside Project were diagnosed with breast cancer in their early forties, some of them by routine mammography alone. Had they not been screened, would they have survived their cancers? No way to know. How much is one life worth? Also, since Dad was a radiologist, I grew up around stories of breast cancer near misses. I know that’s not scientific reasoning, but these new recommendations bring up a lot of feelings for me.
My biggest concern about the task force recommendations is that insurance companies may use this as an excuse to deny coverage for women in their forties who wish to get mammograms. If they have to pay out of pocket, fewer women will get screened, and we might wind back the clock to the days when women only got diagnosed with breast cancer after a lump was detected. Why would we want to go backwards? Is this all part of some government plan to cut back spending on the cusp of health care reform? Are our best interests really at heart? I’m not sure. What do I know?
Breast Thermography
Every woman ultimately has to make this decision for herself, assessing her own risk tolerance. At my office, we offer breast thermography as an adjunct to mammography or as a mammography alternative for those who are young or who choose to avoid mammography because of radiation concerns. If mammograms give you the heebie-jeebies and you’ve opted to skip them, check out breast thermography. Thermography, a non-invasive procedure using digital infrared imaging to assess heat in the breasts, may reflect an increase in blood vessels that are commonly seen with evolving cancer. If there’s heat on the body’s surface, this can indicate cellular damage, increased cellular activity, and inflammation- which may be cancer precursors. Breast thermography may be useful for screening young women, and it may even detect changes in the breast before breast cancer arises.
Breast thermography has some great advantages over mammography. Unlike mammography, which does nothing to prevent breast cancer- only death- thermography can actually assess the conditions in your body that may lead to breast cancer. And these changes can be treated- and often reversed- through dietary changes, lifestyle modifications, supplements, and bioidentical progesterone cream applied to the breasts.
Keep in mind that studies to support thermography as a replacement for mammography are limited. But as an adjunct or alternative for those who wish to avoid radiation or fall into that younger age group for whom mammography works less well, it has great promise.
Breast Thermography
Will I get a mammogram?
You betcha. I just turned forty, so I’ll soon be making the phone call to get my hooters mashed between the plates. I’ve got a three year old, a husband, and a beautiful mission to serve. I’ve got a lot to live for, and I’m not going to let some new recommendations get between me and a long life. But I may not do it every year. I may get thermograms in between (and in addition to mammograms), just to reduce my radiation exposure and assess any breast health issues I might be able to reverse. Ultimately, you’ve got to go with your gut. What feels right to you? When there’s controversy among various organizations, it usually means there’s no one right way. Listen to your body. Ask for guidance from the Universe. Let your boobs tell you what to do…
Freaked out about breast cancer? Don’t be. Fear won’t help. But these tips may (regardless of what the task force says).
Integrative Medicine Approaches to Reducing Breast Cancer Risk
-Practice monthly self-breast exams.
-Eat 5 or more servings of fruits and vegetables per day, preferably raw
-Limit your intake of animal fats, particularly red meat.
-Eat lots of fiber
-Avoid drinking two or more glasses of alcohol per day
-Increase your intake of superfoods high in antioxidants, such as kale, beets, carrots, beans, collard greens, brussel sprouts, and broccoli. If you’re not good about eating your veggies, try Sun Chlorella.
-Drink green juice. It’s a great way to alkalinize your body, and cancer likes acid, not alkalinity.
-Avoid dairy or use organic butter, cheese, and milk, as they are less likely to be contaminated with human growth hormone or estrogen, which is sometimes used to stimulate milk production in cows.
-Use extra-virgin olive oil, raw flaxseed oil, and cod liver oil.
-Expose yourself to the sun. High levels of Vitamin D help fight cancer.
-Exercise. It helps detoxify the body and decreases the amount of estrogen that reaches the breasts. Women who exercise regularly have a 30% lower risk of breast cancer.
-Apply loving energy to your breasts with daily massage. Massage your breast tissue and the area under your arms while you’re soaping yourself in the shower. Close your eyes and visualize healthy breast tissue. Release all fear of breast cancer through a release valve at your root chakra. Dump the toxic energy of fear into the earth’s core and allow the golden light and radiant healing of the Universe to enter through the top of your head. Close your eyes and imagine healing energy extending from your heart, through your arms, to your hands.
-Talk to your doctor about when you should begin mammography and/or breast thermography.
-Be aware of your family history. If you have a first degree family member who was diagnosed with breast cancer before menopause, consider talking to a genetic counselor.
-Limit alcohol intake, and if you do drink alcohol, make sure you’re getting enough folic acid in your diet. If not, take a supplement that includes folic acid.
-If you are at higher risk for breast cancer, talk to your doctor about supplements you can use to reduce your risk.
What will you do, Pinkies? Please share your thoughts.
Loving you and your PINK boobies,
Lissa
PS. Want more? Watch this EXTRA video clip where they interviewed Pinkie survivor Marla Rosner Johson.
[i] National Institutes of Health Consensus Development Conference Statement Jan 21-23,1997. 103. Breast cancer screening for women ages 40-49.www. consensus.nih.gov/cons/103/103_intro.htm
[ii] Elwood, M, Cox, B, Richardson, A. The effectiveness of breast cancer screening by mammography in younger women: correction. Online J Curr Clin Trials 1994; 121:385.
While I chose as models breast cancer survivors because their wounds are so visible, I could have sculpted any group of survivors, and the stories would be equally riveting and awe-inspiring. When people have been to hell and back- and you invite them to tell their truth- what emerges is a slender green stalk that, with tending, blooms into full flower. The women who participated in this project have created a garden for which I can claim no credit. It has been an honor to be their witness.
