The short answer is no!

This morning’s New York Times front-page story suggested that the American Cancer Society was having second thoughts about screening campaigns. The catalyst for the New York Times story was the article “Rethinking Screening for Breast and Prostate Cancer” which appeared in this week’s Journal of the American Medical Association.

In response to the New York Times story, the ACS issued a press release that stated: The American Cancer Society stands by its recommendation that women age 40 and over should receive annual mammography, and women at high risk should talk with their doctors about when screening should begin based on their family history.

Clearly, the ACS wasn’t expecting its concerns about screening to be the highlight of the story. That said, it’s good to see a story that focuses the public’s attention on a conversation that has been going on in the medical community for some time.

Screening is predicated on the notion that all cancers are the same: they grow slowly and then “get out.” This, in turn, suggests that if we can find cancers early we can prevent them from metastasizing.  But all cancers are not the same, there are at least five different kinds of breast cancers and they have different risk factors and different levels of aggressiveness.

Mammography is best at finding what I think of as the slow growing “good” cancers. It doesn’t do as well at finding aggressive cancers when they are still at a curable stage. If “early detection” worked, we would see significantly less breast cancer deaths. But we don’t. Instead, we see a lot more breast cancer diagnoses. This tells us that mammography is finding many cancers that would not cause death in the first place. In the medical field we refer to this problem as “overdiagnosis.” When you diagnose more “good” cancers, the percentage of women dying of breast cancer will decrease. Yet, as we know, the actual number of women dying from breast cancer hasn’t really changed.

What does this mean for you? The message to women over 50 is this: There is data that regular (every one to two years) mammography will reduce a woman’s chance of dying from breast cancer by about 30%.  That is a lot and is worth it. That’s the benefit.  The risk is that mammography will find a dormant or “good” cancer.  What are these lesions? Autopsies of women who have died of something else show that many of these women have dormant breast cancer cells in their breasts that are not clinically significant. If these cancers had been found on a mammogram, these women would have been treated—in fact, overtreated–with surgery, radiation, possibly chemotherapy, hormone therapy, and targeted therapy that they did not need!  All of these treatments have significant side effects, some of which can be life threatening. These include heart disease from some kinds of chemotherapy or blood clots from hormone therapy.

We shouldn’t be focusing on ways to do more screening. What we need to be doing is figuring out which cancers are significant and need to be treated and which do not.  And we need to focus on finding the cause of this disease so that we can prevent the aggressive cancers that are slipping past the screening techniques.  This is the goal of the Love/Avon Army of Women, and it’s why every woman should join today!

Should we change public health messages about breast cancer screening? I think that we might want to consider relaxing the schedule of screening. We are the only country that recommends mammography screening in women every year. We are also the only country that recommends women begin mammography screening before the age of 50. I think we should reevaluate both of those recommendations.

Women over 50 can probably have mammograms every two years. We also should study whether women whose breasts are not dense (we now know that breast density is also a risk factor for breast cancer) might be able to have mammograms even less frequently, since their risk is lower.  In women under 50, there is no data to suggest that mammography saves lives, and it often misses things while exposing you to radiation.

The bottom line: We should probably reevaluate mammography in terms of frequency and age but certainly not abandon it.  And we should focus our efforts not on finding cancers that are already there but into finding the cause of the disease and preventing it.  Join the Love/Avon Army of Women and become part of stopping the disease once and for all.

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11 Responses to Is the American Cancer Society Abandoning Screening Mammography?

  1. Ann Brown says:

    I’m confused, once again. What is a good cancer? Any cancer that is “in situ”? What about small (1.3 cm) invasive cancers? This inability to be precise is disconcerting when you are an affected party.

  2. Heather says:

    Wow, at a general level what you say makes sense, but on an an individual basis I don’t know that I agree. I was diagnosed with Stage IIB at age 42 based on a change detected by the radiologist from one year to the next because my doctor recommended I get a mammogram each year starting at 40. I did not have “dense breasts”, I never smoked, I have no family history of breast cancer, I am not of Jewish ancestry, I was not obese, I had my children at a “young” age and I breast fed them. If I had waited until I felt the lumps (there were two tumors with cancer and another pre-cancer)or waited until I was 50, where would I be now? I had a mastectomy and then 6 rounds of chemo after my Onctoype showed I had a high liklihood of recurrence. I for one am thankful that routine mammograms were recommended at age 40 and that my doctor followed that recommendation.

  3. Susan Love says:

    Right now we can only tell you it was a “good” cancer in hindsight. It is usually hormone positive with a low chance of recurrence, small with no nodes. We obviously need a better way to be sure before we will feel confident about saying that someone doesn’t need treatment.
    As to Heather, you were the exception and a lucky one at that. You touch on a big problem….what is the best thing to do for the majority of women? If we screen everyone we won’t miss the few cases like yours but will overtreat many women with significant consequences. On the other hand if we don’t screen before 50 we will miss the exceptions that screening would have helped. It is a hugh question and probably depends on where ones stands. One possibility would be to have the government fund screening for women over fifty, as is done in many countries, and still allow women to be screened under fifty if they choose.

  4. Pamela Kaechele says:

    I definitely feel I had over kill with my treatments for a 1 cm invasive ductal cancer. If I had it to do all over again I would have had only one surgery (no re-excision) no lymph nodes removed, no chemo and no radiation! I was burned so badly by radiation the skin under my breast sloughed off, I had jelly bean size blisters on the top and was in excruciating pain. Had to stop for 2 weeks at day 21 to heal enough to finish. I don’t do follow ups anymore, only yearly mammograms, but after reading this, I don’t think I am doing that any more either. Maybe every other year or every 4-5 years. Maybe not unless I find a lump. Calling cancers “good” makes it seem unimportant. If I ever get it again, I am waiting until I know the cancer is growing rapidly before I will do anything. Definitely no mastectomy!

  5. I feel I should clarify that my comments related only to me and the type of cancer I had. I know not all breast cancer is the same and have lost friends to it. I do want to pass on my biggest mistake in hopes that it will save someone else from going through what I went through. I was totally shocked when I found out I had breast cancer. I was the first in my family to have it. I allowed doctors to convince me not to get a second opinion and be treated at a large local hospital rather than go to Fox Chase Cancer Center, Thomas Jefferson, University of PA or any number of excellent Philadelphia hospitals I could have been treated at. I tell everyone now, if you find out you have any type of cancer, don’t panic, do some research and go to the very best hospital you can to be treated.

  6. Cindy Austin says:

    Dr. Love – I’m a breast cancer survivor and thriver. Just found this DVD “The Path of Wellness & Healing” at a conference that features your advice and it’s the best resource i have EVER seen for anyone with breast cancer or their families. My husband was given SO MANY BOOKS and who has the time to read when you’re dealing with something like this? This DVD was a one-stop shop that walks you through the entire bc experience with celeb survivors like Sheryl Crow and Christina Applegate and the world’s greatest doctors like Deepak Chopra, Dean Ornish and you! I urge everyone to check it out. You’ll learn, you’l be inspired, you’ll probably cry and you might even laugh! Check it out!!! http://breastcancerdvd.org.

  7. Lois O'Neill says:

    My mother died a horrible death from breast cancer. My first cousin, who was on hormones for 5 years just learned she has breast cancer. I am 65..Just had a menography..Negative.. Never been on hormones. Early peroid at age 10, two children before 30 years of age. Did not breast feed. What should I do. I am of Jewish decent & a bit overweight. I go to Jefferson for pitures every year. Last year they took 5 pictures of left breast…This year 5 pitures of right breast. They saw something, but after additional pictures, they said I’m ok. Should I now go every other year?

  8. Tracy Hastings says:

    I had DCIS in 2005, chose bilateral mastectomy due to big family history. No chemo, no radiation. I was told I was 98% good to go…I got it again almost exactly 4 yrs. later, Stage III this time :( Was it “missed” from the 1st time? Was it a totally “new” cancer? I was 46 the first time, 50 the second time. I found it myself both times … but is there really any such thing as a “good” cancer? I have serious doubts about that … early detection saves lives!!! And if a few extra people have to take a few extra tests in order to SAVE one person, then so be it … what you don’t know CAN kill you.

  9. Evelyn says:

    Shame on you Dr. Susan Love. We need early detection and Mammograms have saved so many lives. Mammograms are part of preventative medicine. Save lives not money!

  10. Marianne Miro says:

    Dear Dr. Love,

    I am sad that you find it necessary to punctuate your belief that we need to change our standard for mammography by demeaning women (many of whom lives were saved by mammography) with your condescending comment “right to radiate yourself”. While I am in full agreement that mammography is not the best way to find many cancers (and in my case it totally missed it), the way that you express your opinion is dismissive and disrespectful. We may not all be doctors, but we still deserve your respect when addressing an issue that could impact our life or death.

    Marianne Miro

  11. Pat M. says:

    Dear Dr. Love,
    Thank you for this article. Some are suggesting we get rid of the use of mamography. Early detection testimonies about how mammograms have saved lives leads me to believe that this screening should not be totally eliminated. I think efforts to make this technology safer would be most beneficial.

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