breast cancer Archives - Screening for Better Health

The Controversy over Mammograms

July 29, 2016 by drjaffer

nci-vol-7496-72 — Image courtesy of the National Cancer Institute

In the past several years, many experts have come out against mammogram screening. The argument, which might seem counter-intuitive at first, is that women may be harmed more on average by a mammogram than they are helped. In fact, at least one expert even suggests that more women may die as a result of mammograms than are saved!

How might this be the case?

As I discussed in a previous article, false positives and false negatives are relatively common in mammography – up to 90% of “positive” tests for cancer (positive means that something, such as cancer, was detected) are actually false positives – the patient doesn’t have cancer after all, even though the mammogram seemed to show they did. And false negatives can happen about 20% of the time when someone actually has cancer, but the mammogram doesn’t detect it.

While these numbers aren’t perfect, many women would willingly take the trade-off between the stress of a misleading test over the possibility of life-saving early detection of real cancer.

But it’s not always that simple, either.

Many times it is unclear whether specific cases of breast cancer will ever develop into a life-threatening illness. Ductal carcinoma in situ, in particular, is when cancerous cells are found solely within the milk ducts, is frequently found during mammograms, and presents many problems with regards to treatment, as it can be extremely difficult to tell if a specific case will eventually become something life-threatening. In any case, women found with these cells are often treated aggressively – which carries a number of significant risks.

Radiation, biopsies, chemotherapy, and even car transit to and from hospitals and clinics can add up to provide very real risks over time – not to mention the stress and uncertainty with living with a cancer diagnosis, even one that might prove to be false upon further testing.

What to do?

This is still a very controversial topic, and we would need to see a lot more data before doctors change their minds about the importance of mammography screenings for women. Health organizations such as the CDC and the United States Preventive Services Task Force (USPSTF) still recommend breast cancer screening for women, though the age to begin screening has been creeping upward, and breast examinations are no longer universally recommended due to poor accuracy.

But it’s important to keep an eye on these types of studies, as the guidelines for screening for any disease are constantly changing and being re-evaluated.

Most importantly, controversies like this remind us that we need to keep pushing the boundaries of medical knowledge. We have to constantly work to improve the accuracy of our tests and the decisions we make for treatment based on our results. One day we will have even more accurate tools for detecting breast cancer; we can always do better.

Uterine Cancer: Screening means Knowing your Risk Factors

May 29, 2016 by drjaffer

Screening for uterine cancer – which affects 2% of women in their lifetimes – is a controversial subject. There is no clear consensus of whether early screening in average-risk women can help prevent cancer deaths. On the other hand, we have a very good idea of what the risk factors for uterine cancer are, and they are relatively straightforward. As a result, the best way to screen for uterine cancer is to simply be aware of whether or not you classify as “high-risk”.

In preventive medicine, there are sometimes risk factors that cannot be controlled and must simply be monitored. In the case of uterine cancer, these are your genetics. If your family has a history of uterine cancer, there is a reasonable chance you have inherited genes that make you more likely to develop this disease. Furthermore, many of the same genetic mutations that can cause breast cancer and are passed down from parents to their children can also cause uterine cancer, so if your family has a history of breast cancer you should also be aware of the potential to develop uterine cancer.

There are also risk factors that are a direct result of actions you take, rather than your DNA. For uterine cancer the first major risk factor is being on hormone replacement therapy, which many women use to control menopausal and postmenopausal symptoms such as hot flashes, sweating, and flushed skin. Taking hormone replacement drugs for 5 years increases the chances of developing uterine cancer 30-fold. While it’s possible to use progesterone to reduce this risk, that has the unfortunate side effect of increasing breast cancer risk, so it is controversial as a preventive tool.

The second major risk factor is Tamofixin use, which is used in breast cancer treatment. However, the risk for developing uterine cancer is generally considered much smaller than the risk of not using tamofixin to treat breast cancer, so while you should discuss this risk with your doctor and be aware of the symptoms of uterine cancer, you should understand that tamofixin is important to your treatment.

There are other, less significant risk factors for uterine cancer, and many of them similarly apply to other cancers and diseases as well. These are things such as obesity, poor diet, tobacco smoke, and lack of exercise. These can be controlled for by living a healthy lifestyle and exercising regularly. Uterine cancer also occurs in a higher rate among women who have never birthed a child, and those with early menstruation or late menopause.

The best way to prepare to beat uterine cancer is to know the risks, know your family history, and know the signs of uterine cancer so you and your doctor can catch it early. The survival rate for uterine cancer is high if caught early – so if you suspect yourself to be at a high risk due to relatives with breast or uterine cancer, be sure to speak to your doctor early in life about the signs you should be on the watch for!

When Mammograms are Wrong: False-Positives and False-Negatives

April 26, 2016 by drjaffer

First and foremost, let’s get this out of the way: Mammograms are often wrong. In fact, some estimates show that up to 90% of “positive” results (those that have detected abnormalities) are actually “false-positives”, meaning that there was no cancer despite the reading. And up to 20% of “negative” results are estimated to be “false-negatives,” meaning there actually was cancer present but it wasn’t detected.

Any screening test has a chance for false-negatives: it’s impossible to detect anything with 100% accuracy. Getting that percentage of false-negatives as low as possible is one of the reasons procedures are constantly re-evaluated and refined. But I want to focus today on the false-positive tests, because the impact of getting a false-positive on your mammography is a little less understood.

False-Positives

This number – up to 90% – may seem unacceptable at first glance. Getting something wrong 90% of the time is usually considered a deal-breaker elsewhere in life, after all!

According to the National Cancer Institute, false-positives are most common in young women, women who have had previous biopsies on their breasts, those with a family history of breast cancer, and women taken estrogen supplements.

Mammograms can also sometimes detect something known as localized ductal cancer. This is the finding of breast cancer that is localized to the ducts of the breasts known as ductal carcinoma in situ. The concern is that many women with ductal cancers may never die of breast cancer that was diagnosed with the screening mammography. These women may be are subjected to unnecessary breast surgery, radiation therapy and even chemotherapy in older age, leading to health problems and costs that were not truly contributing to their long-term survival.

False-positive tests can result in unnecessary procedures, stress, medical costs, lost time, and additional risks. Believing you have life-threatening breast cancer when you do not can be a tremendously disruptive, life-altering experience in the short term with long-term consequences. So how are you supposed to rely on a mammogram with such accuracy rates?

Using Mammograms the Right Way

It all comes down to how mammograms are utilized. The most important thing to understand is that an initial positive test does not necessarily mean you have cancer. In fact, odds are you do not! But follow-up tests will be needed to learn more information and get to the truth behind the positive result. Additional mammograms, ultrasounds, and surgery followed by biopsy are the typical followups, depending on what is found. It is important not to panic at this stage, and to understand that more information is needed before a complete diagnosis can be made.

Another important factor in using mammograms the right way is understanding when they should be conducted. Young women are much more likely to experience false-positive (and false-negative) results: as a result, for average-risk women the American Cancer Society recommends screening starting at age 45, while the United States Preventive Services Task Force recommends screening start at age 50. Screening in young women has not been shown to conclusively help prevent deaths from breast cancer, and may cause more harm than good in many cases. If you are at higher risk or want to begin screening earlier than these guidelines, you should discuss it with your doctor and understand some of the limitations inherent to mammograms.

As women reach their late years, the benefits of mammograms becomes difficult to determine. Women age 75 and older can still develop breast cancer, but in some cases their remaining life span may be less than the period required for breast cancer to become fatal. For women that are still healthy and likely have a number of years remaining, screening may be a good practice. For others, screening may cause more harm than help. It is recommended that you speak with your doctor and try to determine a plan that is right for you and your health as there are no set, agreed-upon guidelines.

Mammograms are still the best tool we have

For all their limitations, mammograms are the best tool for detecting early breast cancer and saving lives. Breast cancer is a fatal disease that takes the lives of about 40,000 women a year. If allowed to develop and spread to other parts of the body, it can be too late to save someone with breast cancer. By staying vigilant and following proper guidelines, it is possible to detect this dangerous disease early and save lives. Be sure to speak with your doctor and schedule the right tests at the right times for you!

Should I still check for lumps? The Controversy over Breast Exams

April 26, 2016 by drjaffer

If you are like millions of other women, you may have learned at an early age to check your breasts for lumps or other abnormalities. The self-breast exam is one of the most well-known screening procedure and an iconic symbol in the fight against cancer. For years doctors have been recommending and performing breast exams in an effort to detect early signs of one of the most common and deadly cancers in the world, an affliction that strikes approximately one in eight women in their lifetimes. But today, many medical professionals have stopped administering these tests in their offices… and have even stopped recommending self-breast exams to women!

nci-vol-1985-150 — Photo by Linda Bartlett for the National Cancer Institute

So what gives? Why have many doctors abandoned a decades-old practice? And does this mean you should stop performing self-breast exams?

The answer to both of these questions lies in the numbers. Specifically, the lack of them showing that breast exams help reduce deaths to breast cancer. In fact, some research has suggested that breast exams, performed at home or by a doctor in a clinic, may actually do more health than good!

There could be a number of reasons for these problems. The US Preventive Task Force suggests that some of the problem may arise because the clinical breast exam “currently lacks a standard approach and reporting standards.” It also highlights the tendency of breast exams to give false negatives, where a woman believes she has cancer but in reality is cancer-free. This can lead to needless tests, biopsies, anxiety, and medical costs, all of which can do a great deal of harm to a patient who mistakenly believes they are sick. The American Cancer Society points to the lack of research supporting the use of breast exams, but reminds women that they “should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.”

There is still research being done on this subject, and many doctors are optimistic that one day a standardized test with reasonable accuracy will be available for women that do not have access to mammograms. And many medical professionals still recommend that women be familiar with their body – even going so far as to recommend traditional breast self-exams. But as a woman, it’s important to understand that scheduled mammograms are your best defense against this deadly cancer – and to understand that, if you do find something unusual with your body, it could mean any number of things. So be sure to talk to your doctor, and keep up with your scheduled mammograms!

For more information on the recently updated Breast Cancer Screening Guidelines, click here!

Why the new breast cancer screening guidelines matter

February 15, 2016 by drjaffer

In October 2015, new breast cancer screening guidelines were published by the American Cancer Society. At the time, we were halfway through the publishing process for our new book. We immediately threw on the breaks and started all over again in order to rewrite the chapter on breast cancer. Even though the ACS is one of several organizations that propose breast cancer screening recommendations, their recent data provides strong evidence that screening too early for breast cancer can do more harm than good.

It may seem like a minor change to have pushed back the starting date for mammograms from 40 years of age (the previous recommendation) to 45 years of age, along with decreasing the frequency of exams after age 54, but the change represents a significant shift in how doctors are approaching early breast cancer detection. [1]

Most people are not aware that 1 in 8 women will develop breast cancer over the course of their lifetimes, and are unfamiliar with the progression of the disease. Breast cancer is a serious life-threatening condition, though the difference in life expectancy between early-detection and late-detection can be enormous. Finding breast cancer early is key… but doctors and medical data have often disagreed on the best way to do it.

While many doctors still recommend breast self-exams, and perform breast exams in the clinic, there is no longer scientific consensus that these tests are effective at detecting early cancers. I’ll be discussing the reasons behind this in a future post, but for now it’s important to understand that the most important and accurate test for breast cancer remains the mammography.

There are several reasons for these changes in recommendations. The most significant is that while mammograms are reasonably accurate tests, they do sometimes result in false positives, and the test performs poorly in young women. The younger you are, the less likely you are to have breast cancer, and the more likely you are to have a false positive test. New research has shown that a large percentage of positive mammograms performed on young women are false positives, and a relatively low frequency represent actual cancers. [2]

A false positive can result in enormous amounts of stress and mental anguish, as well as medical costs, time, and invasive procedures. Unless you are a high-risk individual (in which case starting your screening early is advised – speak to your doctor about this), pushing back the screening start-date should help alleviate the frequency of these false positives while continuing to detect early and potentially fatal cancers.

A review of the new guidelines for women of average risk follows, from the American Cancer Society’s website:

Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45.
Women should be able to start the screening as early as age 40, if they want to. It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening.
At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
Regular mammograms should continue for as long as a woman is in good health.
Breast exams, either from a medical provider or self-exams, are no longer recommended.

It’s important to keep abreast of changing screening recommendations, especially with something as common and potentially deadly as breast cancer!