Breast Health – The Great Debate!
Recently the news has been overloaded with information and opinions over women’s health and mortality as it relates to the use of mammography and self breast exams. With all of this information it is hard to find out what women should do to care for their body. What are the guidelines to follow? Recent studies have documented that there is little to no link between self breast exams, mammograms and the actual mortality rate of women with breast cancer. In this article we will focus not on the answer to that enormous question, but on the ambiguity behind that statement.
It has been the standard provided by the U.S. Preventive Services Task Force (USPSTF) that women 40 or older have a mammogram with or without a clinical breast exam every 1-2 years to maintain good breast health. This recommendation was based on two factors. (1) Clinical studies in women 50-69 demonstrated a 30% reduction in the breast cancer mortality rate when screened annually or biannually (http://www.acpm.org/breast.htm) and (2) the assumption that a women’s breast tissue at the age of 40 would yield similar results. Unfortunately a similar correlation has yet to be found, prompting the new assertion that a women should wait until 50 to have her first mammogram. But is this right? Can one assume tissue changes occur in every woman at a specific age? And why is it important to this debate?
Mammograms are actually not recommended for younger women under the age of 40 for a very good reason; their breasts are denser than the breasts of women over the age of 50. A mammogram produces an x-ray that shows dense areas in white and less dense areas in shades of gray or black. For diagnostic purposes breast abnormalities or lesions will show up as white. Therefore utilizing mammography on young women is not as effective since their very normal, denser tissue make it very difficult for radiologists to read and come to accurate conclusions.
It is the use of mammography on women whose breasts are denser than anticipated that actually leads to the misdiagnosis and painful often unnecessary procedures that have sparked the debate. So is the question of a cutoff for the use of mammography about age or breast tissue density?
It is in fact the uncertainty involved in x-raying a denser breast and the potentially frightening and unnecessary outcome that led to the suggestion that women under 40 years of age learn how to correctly perform a monthly self breast exam. How effective is this though? The argument states that whether a woman follows this religiously or not that the percentage chance of finding an abnormality is the same as a woman who does not. Why? Because the majority of the time a lump is large enough to find, you will probably stumble across it as well. But does that mean you should stop trying to find them before they are that obvious?
The bottom line is that breast cancer is the most frequently diagnosed cancer and is the second leading cause of cancer death among women in the United States which in turn makes it the number one women’s health issue. Unfortunately the study of and results produced have not had enough time to resolve the paradox.
We know definitively that at the age of 50 one should have a mammogram, that our breast tissue can provide a reliable diagnostic tool. We also know that self help exams can be helpful but don’t always show everything that is going on inside. So what is a woman to do? Know your history, know your risk factors, be as informed as you can be and discuss your options with your doctor to come up with a diagnostic treatment you are comfortable living with; and if you don’t see eye to eye with your doctor on this issue then do what you would do if you were unhappy with a pair of shoes, shop around.
The health of your body and your breasts is by far the most important investment you can make!