I have been performing mammograms on women for 28 years. I want to toss my thoughts into this discussion:
Breast Screening programs, at least the ones that I have been a part of, obtain detailed histories from the patients as part of the screening program.
In addition to tracking the results of mammograms, other information is tracked. This information is compiled after a certain period of time and
that is where we get our statistics. For example, it appears that women who were pregnant and breastfed in their 20's seemed to lower the incidence
of breast cancers in that group. Screening programs not only provide regular screening, they track trends and spit out the findings in the reports on
breast cancer that you hear.
In Canada, we have begun providing breast MRI's to high risk patients and most women who undergo breast cancer surgery will have an MRI prior to
surgery. MRI was greatly anticipated to be the end all to beat all in breast cancer screening. Initial reports are devastating. A small study
revealed that women who received the MRI prior to surgery were having larger resections done in order to get cleaner borders around the cancers and
some were found to have more extensive disease than appeared on mammography or ultrasound. It was found that pre-surgical breast MRI had no impact
on recurrence rates or mortality rates. A real blow. I'm sorry that I don't have an article to site this information, it was presented at a recent
Breast disease symposium that I attended.
Another startling fact. 10 years ago, it was am extreme rarity to come across a woman in her 30's with breast cancer, and dealing with someone in
their 40's was uncommon. Ask any Mammographer and she will tell you that there has been a rise in the detection of breast cancers in women in their
30's and 40's. Women in this age group generally have lumpier breasts so doctors were a little slow to react when these patients came in with new
lumps. That is changing. I am performing mammograms routinely now on women in their 30's and 40's, even without a family history. The question I
have though is are we finding these cancers because we are performing more mammograms in this age group and prior to this, were these cancers sitting
there, undetected, and resolving themselves, or is there a true rise in incidence of women in this group developing breast cancer....?
As to the safety of the procedure, I haven't heard a single study address the dangers of irradiating the breast tissue, likely because the risk is
unquantifiable. It's a benefit vs risk issue. Yes, there are false positives and where a mammogram or ultrasound is indeterminate as to the nature
of a lump, biopsy will be recommended and some results come back negative. Some will view this as unnecessary medical treatment. Personally, if
there's a lump in my breast that no one can assure me is benign, I would want it biopsied, or removed. If you're going to question the safety of
radiation exposure to your breast, then I believe it's fair to ask you to evaluate the rest of your lifestyle choices as well. If you smoke, drink
to excess, ingest processed foods with non organic vegetables and fruits, fly south to the sun every winter, then that lifestyle surely has a more
negative impact on your body than a mammogram does.....I'm just saying...
I am a little disturbed by repeated references to women's breasts being "mutilated" by surgeries and biopsies. That infers ill intent. By
definition,mutilation is an act of physical injury that degrades the appearance or function of any living body, usually causing death. I just don't
get approaching medical treatment with an antagonistic attitude. We don't rejoice when we come across a suspicious finding and have to refer someone
for further treatment. I think each one of us offers up a little prayer for these women, so to suggest that we "mutilate" them is a little
As far as breast Cancers resolving them-selves, I believe much more research has to be done. The last I heard was a
out in the 90's stating that up to 22% of breast cancers could be self resolving.
The trick was finding out which ones. If I had a breast cancer detected right now, I would be playing Russian roulette if I sat and waited for it to
resolve. Would I be one of the 22% or 78% ?
In the end, if you don't want to have a mammogram, then don't have one. If you think it's going to harm your breast, then don't have one. Keep
your fingers crossed. Down the road, if you should develop a breast cancer that has spread, then at least you will know that it wasn't caused by
breast screening and if you have to have a radical mastectomy and intensive chemotherapy and radiation, then you will know then that your breast
cancer wasn't a self resolving one......... me, until something better comes along, I'm going to keep having one every 3 years...