According to the American Cancer Society, in 2013, it’s projected that there will be approximately 232,000 new cases of invasive breast cancer, more than 64,000 new cases of in situ breast cancer, and, most alarmingly, nearly 40,000 fatalities due to breast cancer. The numbers are staggering — and so is the fact that the only test out there to try and catch breast cancer early has a skewed approval rating.
“Mammograms are the only test to date that has been shown to decrease the number of deaths due to breast cancer,” says Sandhya Pruthi, M.D., associate professor of medicine at the Mayo Clinic in Rochester, Minnesota. And yet, there's still a lot of controversy over just how effective they are. Perhaps the biggest source of confusion is the question of over-diagnosis of breast cancer, as some cases of cancer detected as a result of a mammogram will not develop into a significant condition.
But, there’s a catch: “No study has been conducted today where we followed these so called over diagnosed cancers say, for 20 years, to see if in fact breast cancer ever did invade or spread,” she says. “There is still much to learn about how these early cancers can be treated more effectively, and maybe with less aggressive measures.” She argues that if a doctor finds something even slightly suspicious, would one really want it left alone, only to find out later that it was actually an aggressive cancer?
The most recent buzz is over a The New England Journal of Medicine study. After crunching the numbers of more than 30 years of U.S. health statistics, mammogram screenings lead to more early detection breast cancers, but the number of late-stage cases is almost the same as pre-mammography. The researchers then concluded that mammograms did not help to reduce the number of late stage cancers.
However, not all experts, including Pruthi, agree. “If breast cancer is caught early, it’s less likely to metastasize, which greatly minimizes the need for toxic therapies such as chemotherapy — it’s the late stage cancers that have poor outcomes,” she says. “I want to be able to tell a women who had a mammogram-detected breast cancer that she has an early stage breast cancer and may be a candidate for breast conserving surgery and will likely not need chemotherapy — not that it’s her only option.”
But you only have to even start to think about getting one until you’re 40, right? Well, not quite. Yes, the majority of breast cancers are diagnosed in women as they get older — it’s estimated that one in 50 will be diagnosed by age 50 and one in eight if by 80 — but younger women can get breast cancer, too. According to Pruthi, about one in 200 will get the disease by age 40; one in 2,500 will by age 30. Even more importantly, more than 50 percent of women who are diagnosed with the disease did not have risk factors such as a family history.
If you do have a direct family link, breast cancer screenings using a mammogram should begin much sooner. To find out what that age is, you have to do a bit of mammography math: Take the age that the first-degree relative (a.k.a. your mom or sister) in your family was diagnosed, then subtract five to 10 years. Whatever that number is, that's the age you should get your first mammogram. So, if your mother was diagnosed at 37, then you should plan on getting your first mammogram when you are 27, just to be safe. If you have multiple people in your immediate family who were diagnosed, then you should take the youngest age of diagnosis and use that as your starting point. One caveat to that rule: Pruthi says she never recommends anyone under the age of 25 start screening because of the concern of exposing developing breast tissue to radiation.
Plus, the power of the self-exam should not be downplayed, because when women stop self-checks, they could miss an issue that leads to or can lead to a delayed diagnosis. “Being aware with the normal changes of your breast is extremely important and essential,” says Pruthi, who tells all of her patients to note what their breasts feels like normally (because frankly, there’s no one-size-fits-all). The best time to go for it: Once a month, the week after your menstrual cycle when your breasts are less tender. Gently sweep the fingers on the opposite hand across the breast like the hands of clock or spokes on a wheel, moving from the outer aspects of the breast to the nipple looking for new changes (i.e. any thickening or lumps). If anything different or new stands out, then schedule an exam with your doctor.
Photo: Rex USA