by Dr. Iain Corness
Mammograms and BSE. Is it worthwhile?
Screening for breast cancer is still a
subject that seems to be controversial, though honestly, I do not know why.
The sensationalist press feeds on fear, and by instilling fear into women
about detection of breast cancer will always sell a few more papers. Despite
mammograms and suchlike, there were cases that escaped detection until it
was too late and other such negative predictions. Was it all then a waste of
resources and money?
No it is not, says the American Cancer Society’s director of cancer
screening, Robert Smith, PhD, who says there is plenty of evidence that
mammograms save lives, even for younger women.
“The American Cancer Society and other organizations have endorsed
mammography screening for women in their 40s because direct and inferential
evidence supports its value in reducing morbidity (injuries) and mortality
(deaths) from breast cancer, the second leading cause of cancer death in
women,” he says.
Other groups that recommend mammograms every one or two years for women in
their 40’s include the US Preventive Services Task Force and the American
College of Obstetricians and Gynecologists.
The American College of Physicians guideline says mammograms can reduce
breast cancer deaths by about 15 percent among women in their 40’s, but Dr.
Smith says newer studies indicate the benefit is much greater - 40 percent
Unfortunately, the cancer detection story is one that suffers from a problem
which can be associated with an inexact science. Since we can put men on the
moon, clone sheep (and even rabbits in Chonburi, apparently) and other
incredible facts, we should then be able to diagnose human conditions with
pin-point accuracy. Unfortunately wrong!
Diagnosis and detection are “real time” arts, not sciences, even though we
would like them to be. Sure, we use science as a tool, but that is all it
is. A tool to help us see the problem. Just like we can use a telescope to
see things at a distance - even if we can’t see the object, that doesn’t
mean to say it wasn’t there. The telescope was facing the wrong way, the
object was behind not in front.
There has been a bit of that thinking with mammograms of late. A lady has
three annual clear mammograms and then finds she has breast cancer during
year number four. Was the testing useless?
Again I ask you to look at the “real time” situation. So today cancer was
found. When did it “start” to grow? This week, this month, this year? The
answer depends upon the type of the cancer. Some fast growing cancers would
be impossible to pick up, even if the person had monthly mammograms. The
slow growing variety can be picked up years ahead. Unfortunately mammography
cannot be a 100 percent indicator - we are not that good - yet. But it is
still one of the best diagnostic procedures we have. And it is better than
Likewise, Breast Self Examination (BSE) has its detractors as well as its
proponents. Sure, a lot depends upon how well the woman carries out this
self testing, but again, surely it is better to look than to carry on in
I do not believe the doomsayers who would tell you that the outcome is just
the same. Breast cancer is like all cancers - the sooner you find it, the
sooner you can deal with it and the earlier treatment is administered, the
better the outcome. In fact, studies from the American National Cancer
Institute show that 96 percent of women whose breast cancer is detected
early live five or more years after treatment. This is called a 96 percent
five year survival rate, one of the ways we measure the severity of life
threatening cancers. If it were a 10 percent figure - in other words, after
five years only 10 percent of the people were still alive, then I would
probably also feel that predictive testing was not all that worthwhile. But
it is not that bleak an outcome - 96 percent are still alive and many go on
for many, many years.
Ladies, talk with your doctor regarding breast screening, and ignore
sensationalism in the popular press!
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