The Great Mammogram Debate

(October 2008) - Because our surgical practice is dedicated to only the care of women’s breast problems, my partner and I are able to stay current not only on the latest diagnostic procedures and treatments, but also the questions and concerns that many practitioners have.

Some people believe there is an excessive emphasis on breast cancer. There’s Breast Cancer Awareness Month, The Race for the Cure, Making Strides Against Breast Cancer, and many other events that highlight the disease. Are there really that many people with breast difficulties? The answer is, unfortunately, yes. About 70 percent of women will develop fibrocystic change in their life before age 70. Over a lifetime, a woman has a one in eight chance of being diagnosed with breast cancer. Breast cancer takes the lives of about 50,000 U.S. women a year, with 150,000 reported new cases per year. These facts alone make breast problems important enough to warrant serious attention.

We now realize that education is a formidable weapon against disease. Through the dissemination of information, our society has come to understand the importance of disease prevention through exercise, healthy weight maintenance, and a balanced diet in addition to judicious screening. Breast health is no different. Some look for newer, stronger treatments to increase the lifespan of women with breast cancer, yet current research tells us a different story. Over the last 70 years, we have discovered chemotherapy, refined radiation therapy, and seen drastic changes in breast surgical techniques. Yet from 1930 until 1995, there was no decrease in the mortality rate of women with breast cancer. Since 1995 there has been a small, yet steady decrease in the number of deaths in women with the disease. Many in the field are sure that this is the effect of mammography that began in the 1980s.

We’re coming to the conclusion that the road to surviving and living with breast cancer is not a new chemotherapy drug, radiation technique, or surgical procedure. The key appears to be early detection of breast cancer when it is small and curable. The best plan for early detection appears to be that recommended by the American Cancer Society:
1. Yearly mammography after age 40
2. Yearly breast examination by a healthcare professional
3. Monthly breast self-exam

This simple but effective plan could save thousands of lives in the U.S. every year. Five-year survival for U.S. breast cancers diagnosed as Stage I exceeds 90 percent.

You’ve probably heard recent discussion surrounding mammograms and their ability to save lives while remaining cost effective. In the last 15 to 20 years, we’ve encountered several controversies about this reliable, effective screening method for breast disease. There have been controversies over cost, accuracy, anxiety caused, effectiveness for women age 40 to 50 years old, and now, questions about whether they lower the breast cancer death rate for women. It has been generally decided that indeed mammograms are cost effective and are abnormal often enough in women 40 to 50 years old to warrant their use. It has also been decided that though an abnormal mammogram that turns out to be nothing cancerous might create anxiety, that unnecessary anxiety is probably worth the alternative of discovering breast cancer after it has spread outside of the breast and may be incurable.

Some have questioned the accuracy of mammograms as approximately 10 percent of people with breast cancer have normal mammograms. If you look at the other side of the coin, 90 percent of breast cancers are found on the test. For the majority of patients, newer technologies such as MRI, ultrasound, and positive emission mammography (PEM) are not yet the answers to general screening.

An annual mammogram probably remains the single most powerful weapon that we have against breast cancer. Early detection through mammography will save many lives. Do I think we need a better test for the early evaluation of breast cancer, as some women’s groups are calling for? Absolutely, and those of us in the field at the Anderson Cancer Institute at Memorial University Medical Center and around the world are working to develop those new tests right now. Until we get a breakthrough in one of those areas of research, the recommendations of the American Cancer Society, the National Institutes of Health, and yours truly all remain the same. Annual mammograms after the age of 40 can save a woman’s life.

Written by breast surgeon Ray Rudolph, M.D., MPH, FACS. Rudolph is co-founder of Memorial Health University Physicians -- Center for Breast Care. This article first appeared in the October 2008 edition of Atlanta Hospital News.