Mammography matters and myths

WELLNEWS

Victor Romulo Gallardo Dumaguing MD

Breast cancer and its screening procedures particularly mammography have attracted worldwide concern in the last decade, as well as heated debates as to when to initiate it and how often its follow up. . Much of the confusion concerning screening mammography guidelines are the result of a controversial recommendation by the United States Preventive Services Task Force (USPSTF) in 2009, in which they said “ that routine screening mammography should not begin until age 50 and should be provided every other year, rather than every year.”
    October is breast cancer awareness month your columnist is happy to share with you the highlights of the 2018 Society of Breast Cancer Imaging/American College of Radiology National Symposium. Multiple randomized controlled clinical studies show that regular screening saves lives and that 40% of the lives lost has occurred in women has decreased by about 35 % which is due largely to widespread availability of  screening mammography under age of 40. The incidence of breast cancer doubles between the ages 35 and 45 and it increases more significantly with every decade, thus age 40 is the optimal time to start screening because approximately 20% of breast cancer occurs in women under 50 years of age, usually in their 40s.
    Critics of early mammography screening claim that the “harm” caused by the results of the screening outweighs its benefits citing the so-called “false positives and over diagnosis.” False positive is when a test says a woman has cancer and in reality, she doesn’t. When a woman is called back from screening for additional test, it does not mean false positive, but an “incomplete not positive result.”
    Others cite the anxiety of being called back for an abnormal mammography result. Many studies as well as experiences of oncologists-cancer specialists- have shown that majority of women would gladly endure a few days of anxiety- the time between the screening mammogram and the problem-solving diagnostic follow up- to find breast cancer at its early stage.
    There is also the myth that women with dense breast tissue do not benefit from mammography. While it is true that routine mammography is less sensitive in dense tissue, it still picks up most breast cancers. However, nowadays, with 3-D mammography, more cancers are discovered early in women with dense and even with very dense breast tissues.
    The American Cancer Society’s position on mammography screening, published on October 2015 in the Journal of the American Medical Association (JAMA) says mortality (death rates) from breast cancer increases when screening occurs every other year instead of every year.
    Dr. Brett Parkinson, managing director for international HealthCare and medical director of the Intermountain Medical Breast Care Center, Salt Lake City Utah adds, “here’s hoping that the latest evidence helps women make well-informed, judicious decisions.”
    Early detection is the best prevention of breast cancer. In general, there is probably high risk in a woman who has first degree relative- mother, sister, daughter- who had breast cancer.  The latest recommendation is for women aged 45-54 to have mammography every year and for women aged 55 and older to have it done every 2 years. Clinical experience has shown that postmenopausal women have their breast cancer growing slower hence, the every two years interval.
    The newest diagnostic test is TOMOsynthesis or the so-called 3-D mammography, as contrasted from the conventional 2-D mammography commonly-used. It provides views of the breast in one millimeter slices, thus giving it a high degree of sensitivity and specificity
    Take home message from the experts. Breast cancer is not a death sentence. With early detection, a woman can enjoy a fulfilling happy healthy life.
    Next Week; Effects of RED MEATS on Health