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“Getting a mammogram is a choice
that should involve an in-depth
conversation with your doctor.”
Eric W iner, M.D.
Results of a doctor-patient online survey
recently published in the
A n n a ls o f Internal
M edicine
mirror Dr. Shanahan’s experience.
Fully 67 percent of doctors who responded
said they would stop offering routine
mammograms to women in their 40s. Mean-
while, only 29 percent of female patients said
they would willingly scale back the frequency
of their screenings— no matter what their
doctors advised. One patient who responded
couldn’t contain her disbelief, writing, “I
really have to wonder what members of the
task force were smoking when they came up
with these recommendations.”
Perhaps even more unsettling is that
some women seem to be giving up on
mammograms without consulting their
doctors. A February 2010 questionnaire
from the Avon Foundation for Women found
that among breast cancer health educators
around the country, about a quarter have
noticed fewer patients under 50 seeking
mammograms since the task force guidelines
went public. How many at-risk women are
falling through the cracks?
AN IMPERFECT APPROACH
Make no mistake: In terms of cost, avail-
ability, and accuracy, mammography is
among the best tools for detecting breast
cancer. But it’s far from perfect. For every
2,000 women who undergo annual mammo-
grams in their 40s, roughly half will get a
false positive result at some point. This often
leads to unnecessary follow-up procedures
such as biopsies, plus general anxiety that
can persist for years, according to one study
at the University of North Carolina. Cumula-
tive radiation exposure is another concern.
An interesting picture starts to emerge
when you compare that with the cancer stats.
For every 1,904 women who receive annual
mammograms in their 40s, one woman’s life
will be saved. (At the same time, testing 1,339
women in their 50s saves one life.) The task
force looked at these numbers and concluded
that for younger women overall, mammo-
grams deliver more minuses than pluses.
Problem is, not everyone agrees. Organiza-
tions such as the American Cancer Society
examined the same data and had a different
take. Otis Brawley, M.D., the society’s chief
medical officer, asserted in a statement,
“...In both cases, the lifesaving benefits of
screening outweigh any potential harms.”
PERSONALIZED PROTOCOL
Now health experts are trying to move
beyond the brouhaha and rally around a
simple message: When it comes to mammo-
grams, don’t make any sudden decisions
before talking to your doctor about your
breast cancer risk factors, lifestyle, and
comfort level with the possibility of false
positives. (For an approximate look at your
breast cancer risk, take the quiz on page
267.) “The task force guidelines were never
meant to be prescriptive,” explains Eric
Winer, M.D., chief of the women’s cancer
division at Dana-Farber Cancer Institute in
Boston. “ The decision to get a mammogram
is an individual— and sometimes difficult—
choice that should involve an in-depth
conversation with your doctor.”
Kathy Smith, for one, is grateful she
decided to get screened in her 40s. Today
she is working with a nonprofit group called
A Silver Lining Foundation, which helps
provide breast cancer education and free
mammograms to underserved women.
“ I was one o f the lucky ones,” Kathy says.
“ Now I’m committed to ensuring all women
are informed about their options.”
E liza b eth W h ittin g to n is the m a n a g in g ed ito r
o f C u reT od a y . com .
BEFORE YOU GO
Screening
Savers
While no diagnostic
technique will ever be
perfect, there are some
steps you can take to
make your mammogram
as accurate as possible.
2
3
4
5
Schedule your screen-
ing for the first two
weeks of your cycle,
when breasts are less
dense. If you’re post-
menopausal, schedule
your appointment for
the same time every
year.
Try to make an
appointment at a
facility dedicated
to breast screening;
such centers have
better accuracy rates.
Research links
caffeine to lumpy
breasts, so avoid
coffee, tea, and other
caffeinated drinks for
about a week before
your screening.
The day of your
mammogram, avoid
wearing deodorant,
perfume, powder, or
lotion. These sub-
stances can interfere
with the X-ray, alter-
ing the image.
Studies show that
comparison aids in
reading accuracy, so
make sure the lab has
copies of previous
mammograms and
ask that new
images are read
against those.
264
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