It seems like every year, a new recommendation is coming down the pipeline about the best ways to prevent and diagnose breast cancer.
Navigating all of the confusion can be difficult, so I’ve got a few simple tips to give you the low-down on what you really need to know to protect yourself.
The American Cancer Society has recently released new recommendations concerning breast cancer detection with mammograms. These recommendations have already generated a great deal of controversy as it has the potential to actually hurt women in the long run. Here’s why.
In the past, many women with an average likelihood of developing breast cancer were encouraged to start having annual mammograms around the age of 40. By “average likelihood,” this meant that they did not have a history of cancer in their family or pre-existing conditions such as cysts and tumors. However, the new guidelines are as follows:
- Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so;
- Women age 45 to 54 should get mammograms every year; and
- Women age 55 and older should switch to mammograms every 2 years, or have the choice to continue yearly screening.
Some of the ambiguity regarding patient options is giving doctors reason to be concerned. Susan Drossman, Elisa Port, and Emily Sonnenblick, all prominent doctors in the field of breast cancer, have written an op-ed piece for The New York Times questioning the decision, particularly a suggestion to end “physical breast examinations by doctors entirely”.
Taking away choices works against your health.
As a breath health specialist, I’ve also questioned this decision. The statement that women from 40 to 44 “should have the choice to start annual breast cancer screening(s)” will mean that insurance providers will not be obligated to cover this important diagnostic tool.
The same is true of the suggestion that women over 55 “have the choice” to continue annual mammograms. If women will be forced to pay out of pocket, they may not be likely to get their annual mammogram. In my professional medical opinion, this can lead to more women falling victim to breast cancer. If you notice a theme to all of this, it’s the cost issue. If women cannot afford to get a mammogram because insurance will not cover it, then they won’t get one and will leave themselves open to breast cancer.
According to statistics on cancer rates in the United States, one in eight U. S. women will develop invasive breast cancer in her lifetime. Since annual mammography screenings were encouraged in the 1990s, breast cancer mortality rates have dropped by 40%. Advances in breast cancer treatment in conjunction with early detection are responsible for this decline.
Why are studies being ignored?
The question then becomes: Why are we suddenly ignoring sound research on breast cancer? This is research that has been collected in multiple countries over decades, but it is being thrown out in favor of these new recommendations. The Nurse’s Health Study, the Women’s Health Initiative, and the Swedish Two County Trial all support the recommendation of screening and the associated decline in mortality. Yet their findings are largely being ignored by these new cancer recommendations.
Why has there been such a major shift in thinking? When did a woman’s breasts become the object of fear? This has actually become so widespread that women are told not to even touch their own breasts under the new American Cancer Society guidelines. This dangerous trend actually began in 2009, when the United States Preventative Service Task Force (USPSTF) completely reversed their own earlier guidelines from 2002. This reversal was not based on any new data. The widespread criticism from the medical and scientific communities of these recommendations have been largely ignored and buried in the press.
Under the Affordable Care Act, 47 million women have access to preventative women’s health services including mammograms. However, if these new guidelines from ACS and USPSTF take effect, insurers will no longer have to pay for an annual screen mammogram.
So, what does all of this mean for women?
This means that breast cancers and tumors will not be found early. Instead, they will be found at larger sizes which increases the probability that the cancer will have involved the lymph nodes and spread to other areas. This also means that more aggressive cancer treatments will become common. Today, early detection has moved us away from disfiguring treatments such as mastectomies. In their place, we have outpatient breast-conserving surgeries like lumpectomy. However, these new guidelines will be a step back to the days of more invasive and larger scale surgeries, more chemotherapy, and more radiation treatments.
Early detection allows for the discovery of smaller, less aggressive and less invasive cancer that has allowed some patients to opt out of radiation treatment entirely. In addition, patients who are not good surgical candidates can opt for less aggressive hormonal receptor treatments that melt away their cancer and keep it at bay. Another technique for low grade, small cancers is cryoablation procedure, which literally “freezes the cancer.”
Early detection is key to saving lives
The key to all of these treatments or whether to treat at all is based on early detection of small sized cancers. 15-25% of breast cancers occur in women who are “pre-menopausal” around age 40-50. 7% of breast cancers occur in women who are younger than 40. These breast cancers tend to be more aggressive and it is early detection of these cancers that can often make the difference between life and death. As we age, our risk of breast cancer increases. But this does not have to be life ending.
Another issue that the USPTSF does not examine is that of breast density, or the increased proportion of fibrous tissue to fatty tissue. Their new guidelines do not take into account the data on this important issue. Increased breast density also increases breast cancer risk by 4-6 times. Approximately 40% of women have dense breasts with 10% having extremely dense breast tissue. This is such an important issue that 24 states have adopted legislation to require doctors to inform patients of their breast density and whether they are also candidates for 3D mammography or 3D ultrasound. As of this writing, another nine states have legislation in process that would also require this.
If these guidelines are allowed to remove annual screening, then that means that there will be fewer options when cancer is diagnosed. The average mammogram costs an insurance company about fifty cents per day. Ask yourself, just what is your life worth?
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