Mammograms – A Gold Standard?
By Zahirah Lynn Eppard
Pink ribbons flood retail establishments and are donned on the uniforms of health care workers and professional athletes. Public Service Announcement reminders flood the airways. This happens in October – National Breast Cancer Awareness month – every year.
A major part of the focus of the “awareness” is educating women about breast cancer prevention. Mammograms are the centerpiece of this campaign today and for more than four decades have been promulgated as the best means of early diagnosis.
While millions of women are familiar with and use this screening mechanism, there are growing concerns about efficacy and the inherent dangers with protracted exposure to radiation over time, especially when other imaging tools that may be considered and utilized.
Background
It is predicted that one in eight women will develop breast cancer in their lifetimes. Other than skin cancer, breast cancer is the most common cancer in women in the US. According to the American Cancer Society it is the second leading cause of death in women (behind lung cancer). At the present time, there are 3.5 million breast cancer survivors in the United States. Mammography remains the gold standard for early breast cancer detection.
The most common indicator of breast cancer is a persistent lump or a thickening of the breast. Bleeding or discharge from the nipple, change in breast shape, swelling, dimpling or puckering of the skin, irritation, pain or tenderness, redness or inflammation of the breast or enlargement of the lymph nodes in the neck or underarm can also be indicators. More than 90% of breast abnormalities are detected by women themselves.
A mammogram is an X-ray image of the breast that is able to detect abnormalities that may not be otherwise noticed or that need further investigation. This screening tool was first utilized for breast cancer detection in the mid-1960s. It is generally recommended that women over 40 undergo regular mammogram screenings. Though there have been improvements along the way, particularly after the United States Food and Drug Administration approved the use of digital breast tomosynthesis (a 3D mammogram), there are three features of the mammogram that may be problematic.
The X-ray itself emits radiation. There is a wide range of opinion about how much of a problem this is. Radiation is a carcinogen and it interacts with DNA to produce a range of mutations. Any radiation exposure can increase the risk of cancer. Medical experts and consumers must constantly weigh the benefits of early detection with the risks posed by screening tools themselves. The American Cancer Society still has full faith in the mammogram. But there are others, like Dr Ben Johnson, founder of the International Cancer Foundation and author of “The Secret of Health: Breast Wisdom” and “No Ma'amograms! Radical Rethink on Mammograms,” who vehemently disagree and push further to suggest that “mammograms can cause radiation-induced breast cancer.”
The test can be unreliable, producing false positive diagnosis and resultant overtreatment. Research has found that mammography screening has led to an increased detection of small tumors, which if left alone, would never progress to an advanced stage. With a cancer diagnosis, many women undergo cancer treatment – radiation, chemotherapy, lumpectomy, mastectomy – some of which has little benefit and potentially harmful side effects.
The Canadian National Breast Screening Study was initiated in 1980 and sought to evaluate the effectiveness of screening mammography in 89,835 women, aged 40-59. The longitudinal study over two decades revealed that “annual mammography for women in this age group had no effect on breast cancer mortality beyond that of breast physical examinations.”
The procedure itself is uncomfortable. The mammogram test is performed by compressing the breast between two plates to spread out the breast tissue for imaging. Typical equipment applies 42 lbs of pressure and causes pain, particularly because breasts are sensitive. In addition to the discomfort, there is a more serious concern. Such pressure can rupture the encapsulation of a cancerous tumor and spread malignant cells into the bloodstream.
Alternatives
It is important to reiterate that there is a consensus that early detection is important in the treatment of breast cancer. But mammography is not the only tool in our diagnostic tool box. There are lesser known options that could be considered.
Breast self-exam is a convenient, no-cost tool that all women at any age should use. It is best to work it into a monthly routine, performing the exam several days after the end of a menstrual cycle. Remember, more than 90% of breast abnormalities are detected by women themselves.
Breast thermography measures infrared heat emissions from normal breast tissue, benign breast abnormalities (such as fibrocystic disease, cysts, infections and benign tumors) and breast cancer, and can do so with a high degree of sensitivity. Thermograms identify thermal patterns in each individual woman. Also known as Digital Infrared Thermography Imaging (DITI), this screening tool involves no radiation or breast compression and no discomfort. It is particularly effective for women with dense breast tissue, a group also at significantly increased risk for developing breast cancer. In spite of these advantages, it is typically not covered by most health insurance.
Breast MRI or magnetic resonance imaging uses magnets and radio waves to provide detailed cross-sectional images that can detect breast cancer. This tool is effective for screening high-risk women or further assessing an area of suspicion found by other imaging tools.
Breast ultrasound screenings use sound waves to make a computer picture of the inside of the breast and can show certain changes, like fluid-filled cysts that are harder to identify on a mammogram. Ultrasound is often utilized in addition to mammography when findings are not conclusive.
It is important for women to be informed consumers. While there are standards that have been established and are useful in many cases, it is important to look for better solutions as science is ever-changing. Ask questions. And do your homework. Your life is on the line.
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