A Message from Dr. Love about the New Mammography Guidelines
I have read and listened to all of the calls and emails that have come into the Foundation since I first appeared on TV talking about the new United States Preventive Services Task Force guidelines. It’s very distressing to me that many of you think that I’ve abandoned you and your concerns.
I have spent my entire career working in the breast cancer field. I want to find an end to this insidious disease. If I thought that these guidelines would harm women, I’d be the first person to speak out.
These guidelines are just that—guidelines. The guidelines aren’t saying that women between 40-50 should never have a mammogram. Women under 50 who are high risk should have a more intensive screening program that includes mammography. Women younger or older than 50 who see or feel a change in their breast should have a mammogram or ultrasound so that the problem can be diagnosed.
What they are saying is that a careful review of the scientific evidence shows that in younger women of average risk the risks outweigh the benefits of routine screening. Understandably, this is a shocking statement to hear, as it completely contradicts the “women should get an annual mammogram starting at age 40” recommendation that we’ve been hearing for the past decade.
What many people don’t know is that this recommendation to extend screening to women under 50 was fraught with controversy. The decision was not based on evidence; it was based on political will. Virginia Ernster wrote an excellent article about this in the American Journal of Public Health in 1997.
Since then, we’ve become even more focused on the need for health care that is evidence-based. This is not just because of the cost factor. (The evidence may show that a more expensive drug or procedure is better, and that’s what we will need to then follow.) It’s because studies have shown us that treatments or tests we thought would be more effective were not. That’s why research is so important.
The problem with mammography in women under 50 is that it doesn’t work very well. Breast tissue is dense in young women and appears white on a mammogram. Cancer also appears white on a mammogram. This means that trying to find cancer on a young woman’s mammogram it is like looking for a polar bear in the snow. As a result, mammography misses many cancers in young women. And not only does it miss many cancers– giving a false sense of security–it also finds many things that are NOT cancer but need to be checked out through biopsies or other tests. In addition, the risk of the radiation is higher in younger women and cumulative so that the additional cancers caused by the radiation have to be weighed against the ones found by the test. It is not as simple as we would like to believe.
The guidelines do not say women can never have mammography under 50 or even over 75, another change that seems to have been overlooked. What it says is that women need to stop and weigh their own risks and beliefs and talk to their doctor and make a conscious decision about the way they personally want to go.
Additionally the guidelines do not say “never do breast self exam or touch your breasts again.” The data shows that formal four-position 20-minutes breast self exam is no better than the usual poking around we all do. The guidelines continue to suggest that women be aware of their breasts; they just do not recommend that physicians spend time training women in formal BSE. Most cancers in women under 50 are still found by the woman herself and not screening mammograms.
Finally, another point that has been missed by the media is the recommendation that mammography be done every other year in women 50-75. This too is based on data. The magic of 50 is menopause. As a woman’s hormones wane her breast tissue becomes less dense and the mammograms become easier to read, shifting the risk benefit balance.
The real issue is not whether mammography can find cancers but whether it can find them at a point that will make a difference in the outcome. The problem is that it is really the ability to find all cancers early that is being questioned. We now know that there are at least five different kinds of breast cancer and that some are so slow growing that it doesn’t matter when you find them, they would never kill you. Others are so aggressive that they will have spread before you can see them on a mammogram. It is only some of the kinds where you can make a difference with screening and it is mostly in women over 50.
What I hope these guidelines will do is push doctors to have a conversation with their patients about the risks and benefits of mammography so that women can make a decision that is right for them. If, knowing the risks, you want to have a mammogram, that should be your choice. But you should also know that mammograms are not all that good at detecting breast cancer in women under 50, so that you can be alert for any changes you see in your breasts. If you are high risk, you and your doctor should develop the appropriate screening program for you. Depending on your age, and your breast density, this might also include MRI. And no matter how old you are, you should see your doctor if you see or feel any changes in your breast.
I had nothing to do with formulating these guidelines but if you look back at what I have written over the years, it is consistent with what I am saying today: mammography is not a good tool for finding breast cancer in younger women and we need to put our efforts to finding something better. I try to do just that and have been involved in the development of ductal lavage, which washes out the milk ducts and collects cells. While we hoped it might be a good early test it has not been found to be as accurate as we had hoped and is now used only as a research tool. At the Foundation, we continue to both fund and do research to find something that will work better than mammography, especially in young women at risk of getting breast cancer.
Also, to be clear, I have not been influenced or received any donations from any insurance companies, nor have I been bought off by our Federal government, nor do I think that these guidelines are part of a government conspiracy. These guidelines come from a respected independent group that issues similar reports on a regular basis. Their last set of recommendations was in 2002. These recommendations are based on an extensive review of the data and took years to develop. It is just coincidental that they came out during the health care reform debate.
I hear your anger. I’m angry too. But not for the same reason. I’m angry because we’ve oversold the benefits of mammography to the extent that there is no longer room to look objectively at the evidence. I am angry that we still don’t know what causes breast cancer and how to prevent it. I started the Army of Women to channel that anger into positive action. I ask that you also channel your anger and frustration into helping us keep breast cancer from going on to another generation! We can do it. We can go beyond finding cancers that are already there to ending this disease all together. But we can’t let ourselves be distracted from the goal. We can agree to disagree about mammography screening guidelines, but we can not let up the pressure and efforts to stop breast cancer once and for all!
I certainly agree that if mammography isn’t as effective as it needs to be (and as we have been lead to believe), more work needs to be done to find something that does. But I have two comments: 1) Please don’t pretend that the recommendations of this task force will not effect what insurance companies will do. Please don’t be that naive. Perhaps that isn’t your concern, but all I can envision is suddenly all women under 50 having to battle to have this basic health screening covered (should we opt to do it), 2) If mammograms are not reliable enough, and self-exams are a complete failure, WHAT are we supposed to do now? You talk about feeling any changes in your breasts, but the task force said self-exams are useless. I have had a lump that my doctor couldn’t even find when I POINTED IT OUT. Please explain how to approach this now, other than discussing with my doctor in the 5 minutes I get to spend with her once a year because she can’t make money unless she sees 40 patients per day.
Okay, I have 3 things: 3) This is an absolute mess.
Dr. Love:
Just read your response to the messages on this board. I want to discuss with you scientifically. Here is a link to an article published on BBC website, comparing breast cancer 5-year survial rate between United States and England.
http://news.bbc.co.uk/2/hi/health/7510121.stm
Basically, Countries like England has been using the exactly same mammography screenign recommendations the new US Preventive Task Force just followed this week. So what’s the difference between the 5 -year cancer survial rate between U.S. and U.K.: 83.9% in U.S., and a poor 69.7% in U.K.
So that’s a 15% increase in breast cancer mortality rate for women in U.K.
Is this where you want the women in this country that you care to follow – i.e., more to die from this disease to save a few extra unnecessary stress?
Most of the so called unnecessary stress today are (1) a few extra mammograms to confirm the findings are benign or non issue; (2) biopsy can now be done fairly quick and easy and much less pain than before.
I am sure you know those better than I. So I am hoping that this data can convince you to change your mind and win back the fighters you most certainly have lost in the last few days.
Sincerely
You do not address the recommendation that mammograms be stopped at age 75. It is FACT that the chance of breast cancer increases with age to 1:8 I believe. So you are writing off women 75 and older? I guess you don’t care if “old” women die.What is the excuse? Certainly not dense breasts! I no longer want to be part of the army of women. I am not providing any more information for fear that it will be used against women in the future. I regret having participated in previous surveys.
Dr. Love,
I am 45 years old, I had NO risk factors, I eat healthy, never smoked, exercise daily, am not overweight, and have NO family history. My breast cancer was found on a routine mammogram. I have VERY dense breast but the digital mammogram CLEARLY showed the cancer. Yes the radiologist said it was like looking for a snowflake in a snowstorm due to the density, BUT it still found it. I work in a radiology dept. The number of mammogram appointments cancelled nationwide today are so upsetting to me. Many women may now die needlessly because of your comments. Thankfully the White House had the good sense to tell people today to still have mammograms at 40. I must say your book “surviving breast cancer” was SO helpful to me. However I do feel betrayed by you. Mammograms still save lives in young women. It saved mine.
Great to hear from all of you and start a dialogue about this topic.
First for the comparison with the UK. Remember the mortality from cancer is due to more than screening but also treatments. If you look more widely in Europe you will find that the mortality rates from breast cancer are less than ours in Italy and France where screening starts at 50 (1999 paper). In a 2003 paper regarding europe they noted: “In some countries with screening programmes, declines in mortality started before screening was introduced, and declines also occurred in non-screened age groups and in some countries without national screening programmes. This suggests that the major determinants of the observed trends vary among the countries and may include earlier detection through screening in countries where this has been introduced, but also improvements in therapy, in countries with or without screening.” It is a complicated issue and we vastly over simplify it when we attribute all advances to screening.
As to BSE, the studies are clear that women and find their own cancers but that it is usually not doing formal four position BSE but rather through the normal poking around we all do. What the guidelines say is that to have doctors teach formal BSE is not useful. They do NOT sat “don’t ever touch your breast again”.
As to women over 75, again they do not say that they should NOT get mammograms only that they should not automatically get them. It depends on women’s health as to whether it is worth it and each woman should decide with her doctor whether to do it. Which is actually what they suggest for women under 50 as well. They don’t say never do it just don’t automatically do it.
Finally I agree if the only downside was anxiety from false positives and unnecessary biopsies it might be okay but the other risk is from the cumulative radiation. YOung women’s breasts are more sensitive to low dose radiation and starting yearly mammograms at 40 will cause as many breast cancers as it will find. With age the breast sensitivity to radiation becomes less and mammograms become more accurate and so it becomes worth it.
Again I appreciate all your comments. I think the media has vastly oversimplified the issues. I wish we could expend as much energy on finding the cause of the disease so that we could stop it once and for all!
Thank you for standing up for your truth while many in the medical establishment sit back cowardly. Without heros like you, patients will never have the freedom to make informed decisions over our own bodies.
Your comment that the decision was not based on evidence but on political will says it all.
I understand the reasons for the change in guidelines, but for me a routine mammogram at age 54 found breast cancer at an early stage. No risks – no family history, healthy – 54 year old woman. With surgery and radiation, I did not have to go through chemotherapy -now this is when I can’t understand the guidelines. What about my daughters?
Dr. Love,
Thanks for responding.
I agree with the mammography issues in women between the ages of 40 and 50 years. What I don’t understand is: Why not promote a monthly self-exam in the breast? It’s very noninvasive and doesn’t even cost anything. I believe a woman should take responsibility in examining her breasts, not a doctor who is unfamiliar with the topography of her breasts. I also found (during the year I was being treated for IDC) that most doctors don’t do a good exam!
Why is it that whenever we attempt to introduce rationality into our health care system, we are accused of rationing? The reaction to these new guidelines bodes poorly for any meaningful attempt to reform our health system. Thanks so much for your courage and your adherence to science. I for one was delighted with the new guidelines.
I don’t understand why you say that mammography does not work for women in their 40’s. My annual mammogram clearly showed microcalcifications that had changed from the year before. Thank goodness the radiologist went ahead and ordered a biopsy. As the surgeon who did my biopsy told me when she told me I had cancer, this is exactly what annual screening with mammograms is supposed to do. I had surgery and avoided chemotherapy.
Dr. Love,
I am writing to encourage you during this time of misunderstanding and doubt. While these guidelines have little affect on me, I have long been a proponent of evidence-based medical practices. For instance, I do not plan on getting a PSA test when I am older as there is no evidence that it helps prolong life.
Thank you for doing your part to help Americans understand that more is not always better.
What happened to the concept of early detection? The earlier you find it, the greater chance you have of not dying from it. As to me, I feel betrayed. I have had mammograms from the age of 40. I am now in my 60’s. My cancer showed up on a mammogram in 2004, but instead of a biopsy, they sent me to a surgeon who couldn’t feel it. That continued until I started having a discharge a year and a half later. Three months later, my right breast was x-rayed at least 6 times (mammograms), had ultrasound, and then a needle biopsy. Since my radiation, I had mammograms every 6 months for 2 years. If these mammograms are so bad for women, I have had more than my share. I think that it is more about money than it is about saving lives. This guidelines don’t affect me, but they do all these younger women who will likely die from breast cancer.
Susan,
I, too am disappointed in your support for the new guidelines. I was diagnosed at age 53 by digital mammogram. By these guidelines, my cancer would not have been picked up until age 54. I had Stage 1 and Grade 3 cancer (very aggressive). The fact that they caught this cancer in early stages gives me a better chance of living. I had been called back on my mammograms many times before and experienced the stress. That stress only lasted a short period. It was worth the stress so that I have a better chance to survive now. I will not be participating in your Army of Women program anymore.
Dr Love I agree with you completely and have to say kudos for being brave enough to state it publicly in this pink crazed culture we find ourselves in. I think what people aren’t getting is that no one is saying screening isn’t necessary, they are saying the screening methods we have aren’t nearly as effective as we like to believe. Women under the age of 40 have very dense breast tissue and mammography is not that great at picking up cancer in dense tissue. I know there was a study using T-scan to screen women with denser breast tissue (40 – 50) I participated and it found masses that my mammogram missed. Here’s hoping for new technology and a bit of sanity! thought to be more effective in
Dr. Love:
I appreciate your reply. Yes, there are studies showing smaller benefit of mammography in some countries, but there are equal if not more studies showing the significant benefits of mammography in reducing breast cancer mortality. Also the qualities of the studies varied vastly from one to another. So people like me and you can always find so called scientific data to support our own opinions. That is what makes this more difficult of a debate to know the real answers.
However, you and I are both in the prefessions that help woemn to detect and treat their breast cancers. So, in addition to the scientific studies, we are capable of generate conclusions from our own experiences. I think this is where we differ in our opinion.
I believe we can agree that there are many women under 50 develop cancers in their breasts. And many of the cancers are more invasive than those found in older woemen. I also believe that we can agree mammography helped many of those women in their 40’s by finding and treating the cancers at the early stages. You can never convince those surviors either BSE or mammography did not help them. Some peole like you called they (the surviors) are not scientific from telling their life stories, but what is science. Science is about common sense, and is about life experience of real people like them, you, and me.
I honestly believe, given your history, where we start to differ is that I looked at the importance of the life saved/affected, not only the women with cancers, but their loved ones around them. You talked about stress to some small fraction of woemn who sent under through unnecessary diagnostic procedures. But what about the emotional devastation to the loved ones of women who may have died from breast cancers if their cancers become uncurable once they follow the new guidelines.
I honestly believe that you think we need better methods to detect and treat breast cancers. That’s why I encourage people who supported you in the past to continue their support for your work. However, I can never agree with your logic of just telling women in their 40’s to just sit around ad wait for a better thing that is not available.
Sincerely
Dear Dr. Love,
One thing that you haven’t mentioned is that the USPSTF recommendations are based on decreased mortality rather than life years gained. This is mentioned in their supporting article, which can be found at http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanart.htm. The authors acknowledge that “If the goal of a screening program is to efficiently maximize the number of life-years gained, then the preferred strategy would be to screen biennially starting at age 40 years.” The authors also acknowledge that life years are “the measure most commonly used in cost-effectiveness analysis.”
It is not clear why U.S. screening recommendations should be based on decreased mortality rather than increased life years. Perhaps you could address that issue.
Thanks for all the good work you do. I have benefited greatly from your book and your website.
Sincerely,
Corliss Swain, Ph.D.
Dr. Love:
Regarding your comments about radiation dose to breasts – in the last two decades, mammography equipment has seen drastic improvements not only in imaging characteristics, but also in terms of radiation levels used for imaging. The radiation dose to breasts has rduced by more than 50% in screen-film systems, and for digital mammography equipments, the reported dose level is about 40% less than screen film mammography. So the radiation level is so low now that most experts do not even consider it to be a risk factor for discussion.
Again, scientists/doctors are no different from oridinary people. We are always looking for reasons to justify our own opinions. I only hope that we put our mouth where our hearts are – care about the people we serve in our professions. If we do not know the true clinical outcome, we should use our own experience to form our judgements –
so the question to you really is how many women with breast cancers in their 40’s you have seen and treated in your career? If you never saw any of them, I don’t blame you for your opinion. If you did, how can you tell them their lif is not worth of saving by using the bext tools that are available to them today. That is BSE and mammography.
Sincerely
Dr. Love,
Thank-you for your strength and rationality in the face of the abuse you are taking. Also, thank-you for finally saying loud and clear what few would dare to point out: that “starting yearly mammograms at 40 will cause as many breast cancers as it will find.”
So what you are saying is that early detection doesn’t make a difference. Had these guidelines been in place when I was diagnosed they wouldn’t have found the 1cm invasive ductal cancer in my breast. According to you, finding it early makes no difference in whether or not this cancer will kill me someday. Had I left it alone for a few more years, my risk of death from it wouldn’t be any greater. So, tumor size doesn’t matter.Since women die from invasive ductal cancers, I can only assume that I will die from it someday as well, that there is no such thing as saving a woman’s life because a cancer was caught early. Talk about confused! Your logic is so illogical! Oh wait, maybe you meant my life wasn’t worth making 100 other women have a mammogram and find out they have completely normal breasts? So, early detection is a myth? Great. Lesson learned, there aren’t enough women dying of breast cancer to make yearly mammograms beneficial. When you said women at low risk don’t need a mammogram until 50, you obviously didn’t read all the comments. Most of the women including myself were LOW risk, the first one in the family to get breast cancer and younger than 50. Hello! If you think the insurance companies will keep paying for yearly mammograms for women who want them, you are living in fantasy land!
Dr. Love:
I hope you have read the comment from “Rebekah”, and seen the how confused s/he is by your statements – screening at 40’s cause many breast cancers???
You still don’t get it. Any life saved is worth all the false positive results. Can you put a $$ figure on a life? My parter was diagnosed at 42. If she had listened to you she would be dead. We are not statistics. We are not anecdotes. We are people who’s life has value. There you sat on those morning shows all full of yourself, mocking those of us who belive that if a mammogram can save one life it is worth it. I’m not fighting for my “right to radiate” myself, I’m fighting for my right to use ANY tool available to not die from this awful disease. You are giving power to the insurance companies to once again find a way to deny women good health care. And as far as your statement that mammograms cause women “stress and anxiety” from a false positives, do me a favor, let me decide which is worse – a few days of anxiety or a delayed diagnosis. You sounded like you fell out of the 50’s and didn’t want women to worry their pretty little heads about it…give me a break.
I think you should have emphasized for the news media that all women should be evaluated by their doctor as to whether they are at high risk. Should they be tested for BRCA? Do they have a history of breast cancer in the family, are they doing self exams frequently, etc.
The message came across as being very generic. Perhaps a rewrite is in order?
Thanks for your good work.
Dr. Love,
I hear what you are saying about the science, but have so much personal weight in the other side of the debate. I found my breast cancer this spring after meeting a woman who was diagnosed following routine mammography in her 40’s. Her story plus the nagging of my OB/GYN to resume self examination drove me back into BSE. First time I did the BSE, I found a lump. I know that I am lucky, in that my cancer was very small, and resulted in a lower Oncotype DX score so I did not need chemotherapy. I wonder if that would have been the case had I not been diagnosed at that early stage? Mortality can’t be the only value measurement in this debate.
The main reason I had stopped doing BSE was the study a number of years ago that reported no benefit from BSE. When I resumed it this year, I’d had the opportunity to see and handle a training tool at a breast cancer awareness booth. I know doctors do not need to be spending time teaching women how to examine their breasts, any more than they need to be teaching lamaze breathing. Why can’t the concept of BSE, with these training tools, be rolled out in high school health class, or the training tools be made available next to the scales in doctor’s offices.
So much incredible work has been done on this suite of diseases that breast cancer is. Let’s keep moving forward.
Dr. Love,
I found a breast lump on self-exam at age 28. Surgery was performed and it was found to be benign, but because of this my breast center doctor recommended annual mammograms. When my mother was diagnosed with breast cancer two years later, this history information made the doctor even more emphatic. I was told that the radiation level was so low that it *wasn’t* a risk factor for breast cancer. Now I read the new recommendations and your statement that mammograms from age 40-50 can cause as many cancers as they detect, and I feel absolutely sick and horrified–I’ve had 20 mammograms I shouldn’t have had?
This topic is full of controversey, and my hope is that through this controversey, something will be resolved to better the lives of all women. My BC too was caught on a routine mammo @ age 46. I had a clinical exam 3 mos. prior and because it was a mass (1 cm) not a lump, it wasn’t detected. With one positive lymph node, the std treatment at the time (2007) was chemo, radiation, followed by tamoxifen. Was my cancer life-threatning? I don’t know. Was I over-treated? I don’t know. I actually hope it wasn’t life-threatening because I hate to think I had anything in me life-threatening. I put my trust in my medical team with their “statistics” because when you hear the word “cancer” you want it out of your body and will do everything possible for it won’t come back. I have made it through my treatments stronger than ever: physically, emotionally and spiritually. No harsh words for you Dr. Love, I am sure you have your reasoning for your views and you are entitled to your optionions. We sisters are just in shock right now and we are a tight group that will defend what has been drilled into us for years. I wish your “Army of Women” the best, which I will remain a member of, because we need to find a cause to this dreadful disease so we won’t have to worry about these issues any more.
Dr. Love,
Thank you for so eloquently explaining. I think I myself as a 4 year survivor who was 40 and dx on my 1st mammogram feels that PJ Hamel BEST explains my feelings
http://www.healthcentral.com/breast-cancer/c/78/95172/reluctantly?ic=506011
but, you definately provided more info and hope more of this is shared with the public in the hopes of defusing the controversy. Thank you again.
Dear Kay:
Dr. Love is an epxert in oncology, but she is no expert in radiology and has no expertise to make any statement in the risk of breast cancer due to radiation. If you want more information, you can go to MQSA and FDA sites for more reading on radiation levels and their risks.
I think it’s very hard for women to change their mindset away from mammograms, mammograms, mammograms. As we know, mammograms MAY find cancer, but they may NOT. We have been lulled into a false sense of security that if our mammogram is negative, then we are okay. In reality, because a woman’s breast tissue before menopause is too dense, many negative mammograms may be unreliable. As you say, the most important thing is to prevent this disease BEFORE it happens, instead of trying to detect it. I fully support you and your work, and I’m so sorry that you feel under attack.
Sadly indvidual stories don’t constitute science. We already ration care in this country since 20% of all women of child bearing age lack health insurnace. This is as high as 39% for hispanic women so the 5 billion a year spent on unnecessary testing is forcing these women to receive rationed care.
I don’t support pitting one group against another and yes all life is priceless but grow up people. Tons and tons of medical care has nothing to do with outcomes or need. Only 8% of diabetics get the right care for example but there is no outcry to treat them properly.. BTW diabetes account for 35% of all medicare costs but are only 10% of the population.
Focus on what works and not what has been marketing to us. Dr Love is ahead of the curve and I for one stand by her.
OBGYN found lump and told me it was nothing. Just fibercystic changes. Not to worry. Even with a palpable lump, he told me there was no hurry on the mammogram. I went a month later for my first mammogram and was diagnosed at 41 with stage 1, grade 3 IDC Breast Cancer. Doctor was shocked. He is no longer my OBGYN.
Before issuing these new guidelines, how about educating the medical community that young women can and do get breast cancer. If a lump is found in a woman of any age, it should be checked out. Statistically, it is probably nothing. I would give anything (actually I did, both of my breast) for my doctor to have been correct and only had a little “anxiety” over the whole situation.
Guidelines or no guidelines, I tell my story hoping to ispire women to take control of their bodies and health choices. We must be our own health advocates.
I agree with the new guidelines based not only on my own experience with mammography but that of my close friends.
When I was in my early 40’s I found less than a pea size lump in my breast through manual self examination and naturally I went into panic mode. I visited my gynecologist who sent me for a mammogram. The mammagrom was done TWICE on my breast because the incompetent techs didn’t get it right. And I am educated enough with a Master’s Degree to know that they double dosed me on radiation to that breast.By the way there is NOT enough information disseminated about women’s yearly or biannual exposure to the radiation coming from these mammograms. I hear NOTHING about this from the mainstream news media..Additionally, the standard of the technology is erratic across the country. Once again, women are SHORT changed of information where their bodies and health are concerned. Wake up, everyone.
Next, back to my situation. The mammogram, done TWICE on the same breast did not pick up the lump..I was told I had “dense breasts” which is common among 40’s aged women.. so all that trouble for NOTHING. If I remember correctly, I was then sent for an ultrasound which found the lump. Next, I was
given an excisional biopsy under local anesthetic and the lump turned out to be a fluid filled cyst. Now why anyone would want any cyst or hard lump sitting in their breast is astonishing.. so I do not understand the rationale of saying the biopies are all the unecessary trouble. I was glad to get rid of the cyst, period. But as for the NEW guidelines they make sense and do not rule out alterations in approach for those women who have familial cancer histories, etc. That is between the doc and patient. I wish some of you people would stop your vitriole
and destructive hostility and think about how you have been hoodwinked about the welfare of your bodies over decades.
Dear Dr. Love,
I am a woman in my early 40’s who was diagnosed this year with breast cancer because of a baseline mammogram. I am very sad and mad that these guidelines came out and also very confused by some of your comments.
I am currently going through radiation treatment and assume that as a follow-up to care, I will receive (at least) yearly mammograms. Your comment about radiation having a greater effect on younger women and that it may cause cancer absolutely scares me. I am sick at the thought 20-something more treatments to go and follow-up care.
Can you please elaborate on the effects of radiation in younger women?
Thanks,
Deb
Thank you Chris! Well said!Dr Love you are obviously reading these posts and for that I thank you. However you never address the people (like myself) that were very low risk (the people you say should wait until they are 50)that have been writing you about finding breast cancer on a routine mammogram in their 40’s. You have read countless stories on your blog about women in their 40s finding breast cancer on mammograms. Weren’t our lives worth it? In my opinion saving even one life is worth it. I am also saddened by the women that justify not having a mammogram,ultrasound or a biopsy because of the anxiety. Imagine the anxiety those of us had when we were actually told we had cancer. It dwarfed the anxiety we felt during the mammogram. Imagine the guilt and anxiety I would have felt if I hadnt caught this early with annual mammograms. I would never have been able to look at my 3 kids faces again knowing that I could have prevented this with a simple mammogram.
What is the scientific basis for your statement that “starting yearly mammograms at 40 will cause as many breast cancers as it will find.”? Broad, unfounded, inflammatory statements like this call into question the validity of your entire argument.
Dr. Love,
Thank you for responding.
I represent the 30-something group of survivors…
I was diagnosed at 33 and have no family history or obvious risk factors. Considered “low-risk,” I was never encouraged to undergo early screenings.
In my late 20’s, however, my very astute OBGYN recommended that I perform regular BSEs. In less than 5 minutes she was able to teach me the correct way to perform the exam, and explain the importance of “getting in there” and getting to know the feel of my own breast tissue. She explained that, with regular BSE’s I would come to know if something felt wrong. She was right.
Last November, I did find a tiny, aggressive, 1cm tumor, which I don’t believe would have been found through the “normal poking around” you refer to.
You wrote,
“As to BSE, the studies are clear that women and find their own cancers but that it is usually not doing formal four position BSE but rather through the normal poking around we all do. What the guidelines say is that to have doctors teach formal BSE is not useful. They do NOT sat “don’t ever touch your breast again”.
BSE saved my life, and much credit goes to the doctor who took 5 minutes out of her day to teach me how to do it properly. No study, or expert, can tell me otherwise. While I appreciate your efforts and dedication to the cause over the years, I think you are doing a disservice to young women in particular, by not acknowledging stories like mine. One life does matter.
Until there is better screening tools available for women like me (the under 40 group), I just don’t understand why experts like yourself continue to make statements, and support guidelines, that discourage the BSE and the formal teaching of it. I am living proof that it does, in fact, work!
People, this exam costs nothing (go figure!). It can save lives. Don’t let any panel of experts tell you otherwise.
My mother died of breast cancer when I was 21. I am glad my ob/gyn didn’t listen to you or any other “guidelines.” He started sending me for yearly mammograms at that time, and it’s a good thing, too. I was diagnosed with Stage III breast cancer (very fast moving, hormone driven) at age 47 — and I had to fight tooth and nail to get anyone to listen to me because I didn’t fall in the “guidelines.”
So, my 26-year-old daughter, whose grandmother died of breast cancer and whose mother had an aggressive breast cancer can’t get a mammogram paid for because of the “guidelines.”
Your precious “guidelines” make it possible for pencil pushers to make vital decisions regarding my and my daughter’s health.
The one thing I learned in my statistics class in college is that numbers can be manipulated to say whatever you want them to say.
The awful thing about this is that feminist literature was publishing questions about mammography as “the solution” for breast cancer detection as early as the 80’s, but the whole discussion over appropriate prevention, diagnosis and treatment has been polarized past almost any civil discourse. Adherence to a health care modality is still a very fundamentalist POV, which is necessarily at odds with Science.
Wishing you well with your work, in that context. Thanks for taking your turn pushing the boulder.
I too am not sure how I feel about the Army of Women study I am currently participating in… I too represent the YOUNG people who are diagnosed with this disease (Stage 3) with no family history, risk factors. I belong to an organization of young women who were all diagnosed under the age of 40 and many who did not have risk factors. Many of these women found their lumps by SBE’s and many by mammogram. I ABSOLUTELY defend that every single one of their lives as well as every friend, family, neighbor, stranger’s lives is worth not having to face what I faced this last year. Anxiety, that’s being told YOU HAVE CANCER. Relief is a negative mammogram, not finding a lump during SBE and hearing benign from a biopsy. I really don’t think you realize the ramifications of your words to the young women of America and I am really sorry that your organization and Army are going to suffer from the decisions you have made.
Dr Love –
All of the controversy is unfortunate, but preventable in my opinion.
If the primary message is that we need better screening options, then that should have been the lead story. All of the other info, valid as it may be, is going to invite an emotional response. While I agree we need to know it all and make evidence based decisions, I think it could have been positioned better as a call to action.
Bottom line, none of us want to feel left behind by the medical community, nor do we want ourselves or our friends to die while waiting for a cure.
Best of luck in sorting it out and educating the confused general public.
Any radiologist will agree that a mammogram is not a perfect test but its the best test we have right now. If anyone thinks for a second that radiologists make much money off reading mammograms, that couldnt be farther from the truth. The increased malpractice premiums they pay because they choose to read mammograms is outrageous. Medicare reimburses them less than $40 for a mammogram! Breast MRI’s are a great option but they are expensive, and alot of insurance companies wont pay for them. And FYI is no radiation in an MRI. Women need to make there own decisions. but dont be fooled to believe that because you are low risk you wont get breast cancer.
I read the story and hear all over the news about the government task force who think they know better than the American Cancer Society at what age I should start getting mammograms. Since when do these people know more about cancer than the American Cancer Society? None of them are oncologists, pathologists, or radiologists
Is this really the path my healthcare is going? I was diagnosed via mammogram at age 45 with invasive ductal carcinoma AND an invasive cribriform carcinoma, multifocal. 6 masses total, the largest was 2 cm, the second largest was 1.5 cm and NONE were palpable. They were found on mammogram and would have ONLY have been found on mammogram. Again, I have two invasive forms of cancer and it is multifocal. Do you know what that means? It means, 5 sites in one year went cancerous and one already spread to a 6th site. IN ONE YEAR!
My digital mammogram from the year before was clear, I saw it, I looked at it, like I do every year. In the period of a year an extremely aggressive cancer started. Where do you think I would be if I had not had a mammogram until the age 50? I would be a STAGE IV and would not be a survivor. I would have been dying or I would have been dead by the age 50. Is that their plan? Save money because we’ll be dead already? By testing at age 40 we are only saving a few? My family thinks I’m important enough to save. You don’t think I am important enough to save?
Even with my early diagnosis and bilateral mastectomy and chemotherapy and hormonal treatment that will last 5 years, I have an 80% survival for 10 years. ONLY 80%. But that is far better than 0%. I had no family history, no risk factors other than the fact I had not had children, no BRCA genes. I was low risk and yet I got a multifocal cancer at age 45. I WAS LOW RISK.
I am fighting way too hard and sacrificing almost everything to fight this right now including trying to NOT LOSE MY HOUSE! And I’m one of the fortunate ones because my cancer is grade 1 and STAGE IIA. It was found early enough so that I didn’t have positive lymph nodes or metastasis to other areas of my body.
I am a nurse. I work in critical care. EVERYONE I talk to is appalled at where our healthcare is headed. This is just one example of the rationing we will see. If I’m dead before 50, well, the government saves costs, don’t they. I think this is on what they are counting. Didn’t most them take the hippocratic oath? What does that say, do no harm? THIS WILL BE DOING HARM. AND YOUR SUPPORTING THIS???
What are they going to do about reconstruction next? Are they taking that too? Now I get to look like Frankenstein the rest of my life, is that going to be next?
They say 1 in 1900 are saved with a mammogram in their 40’s. I’m talking to more people than that number! Why don’t you just hop onto the Komen board and see how many THIS YEAR were diagnosed and saved in their 40‘s and even 30‘s. Its more than 1! I’m being told the stress from a false positive is unnecessary. I hoped and prayed for that false positive. I would have celebrated with that false positive. I would rather get a false positive every year of my life than to have been diagnosed with cancer or die from it. It would have been much less stressful than what I am going through now. My mammogram was a life saver! I can’t believe, you of all people are backing their recommendations. Your either with us or against us, sounds like your against us.
Sincerely,
Paula Shelton, RN BSN
I was diagnosed with DCIS via a routine mammogram at the age of 45. My only “risk factor” was having a child at the age of 41. At any rate, the DCIS was high grade and extensive within the ducts (my mammo 2 years prior had been clear).
I did my research (including reading your book as well as a number of other sources) and I asked for a mastectomy–actually got a bilateral with immediate reconstruction with absolutely NO regrets. My breast surgeon was actually relieved I think, because she didn’t have to convince me given the amount of DCIS in the breast (she was supportive of my choice of mastectomy as a personal decision).
At any rate, after surgery the pathology revealed that indeed the cancer had begun to invade. Fortunately for me, it was micro-invasion and my sentinel node was clean. I had no need for chemo or radiation and now, 7 years later am fine.
Perhaps I am a statistic, but clearly the mammogram “saved” my life. My surgeon even used the term “dodged a bullet” when discussing my path report.
I started my own website to help women find information on the internet so that they could make informed decisions as to what was best for them.
I understand that mammograms are imperfect and not the best method to find all breast cancer. However, had it not been for the existing guidelines, I would have faced a very different prognosis.
I have had two other friends who were diagnosed at age 40 via mammograms. Both are alive at 52 and doing fine….I also have to friends diagnosed last June, one via mammo (age 44) and another through finding the lump herself.
I also had another friend get a biopsy after a suspicious mammogram+sonogram—fortunately, she did not of cancer. I asked her about the stress and she said it was a small price to pay.
There are no simple solutions to this….but I still believe mammogram under 50 is important. Hopefully, in ten years this discussion will be moot and we will have found much better screening methods. Perhaps we will even be able to prevent more cancers before they even begin….
My breast cancer was detected by mammography at age 45. It was nonpalpable and I was considered low risk. The guidelines indicate only women under 50 considered “high risk” should recieve mammograms. Obviously our scientific understanding of who is truly “high risk’ is very limited. Right now research has only been able to identify a genetic component that you yourself have conceded makes up a very small portion of breast cancer cases. Mammography is not perfect, but until better tools are developed, it is the best we have. Studying the entire spectrum of breast cancer is necessary to develop diagnostic tools, treatments, and a cure. The new guidelines would virtully eliminate the scientific data from women under 50 unless they have an already identified genetic component because the “low risk” women would no longer get mammograms or biopsies.
I was upset when I heard the new guideline because I felt it would put women at risk fro getting metastatic breast cancer. Then I saw you on TV and I have such high regard for you that I am willing to rethink the situation. Do you still feel that mammogram should be done every other year between 50 and 60? i was diagnosed at 56 by mammogram. I wouldn’t want it to have been a off year. I am fine now and consider cancer something from another lifetime.
I was in shock at the comments made by Dr. Love during this week’s GMA interview. Most upsetting to me were her comments:
1. “mammograms have never been shown to work in women under 50″. An early mammogram saved my life. I have no family history!!! I was diagnosed at 42 and was already at stage III. I don’t think I would be around to celebrate my 50th birthday had it not been for that first mammogram.
2. “…oversold the notion of early detection..” It’s because of early detection and treatment that I am here living my life cancer free for the past 4 years!!!
3. “…can it change theoutcome in a sufficient number of women…”
I am sick to my stomach thinking this panel of researchers and now Dr. Love feel 3% of lives are not significant enough. I am sure my 11 year old son, husband, and family would disagree.
I’d like to ask Dr. Love and the panel one simple question…Since when did young women lose their freedom of life in this country?
I no longer trust Dr. Love, her study and any statistic she may publish. And, am removing my participation in her army of women coalition.
Dr Love,
Like many women, I was ‘mad’ at first about these ‘new’ guidelines. I think the media has not been too clear on the recommended guidelines. They say something different each night. Your explanation cleared up many of my questions. I feel if you want a mammogram, talk to your doctor. Everyone is an individual. Hearing that women were calling their doctors and cancelling their scheduled mammograms coming up is foolish. They only have themselves to blame. I firmly SUPPORT the ARMY OF WOMEN and the research going on and our best bet right now is finding the cause and get rid of this awful disease once and for all. Thank you.
I have just been sitting here reading all of these responses to the new guidelines. I to am a survivor. I thought I was to young at 49 to have this disease but sat through 6 rounds of chemo with women in their 30’s and 40’s.
My question is how do you compare the amount of radiation I have had to my breast, with a mammogram once a year. How does one know if they are high risk without tests one of the best tests for BRAC gene is not covered by insurance. My tumor was clearly on the mammogram film and I am grateful for this tool. Please don’t tell women not to rely on the best tool we have at this time. We have made so many strides to have us be told to go backwards. What’s the conclusion for those that are younger than 40 with breast cancer – oh they don’t count. My feeling is I can live with a little anxiety but can’t live with a LITTLE cancer.
I like to know if anyone on the panel has had breast cancer.
You said: “The problem with mammography in women under 50 is that it doesn’t work very well. Breast tissue is dense in young women and appears white on a mammogram. Cancer also appears white on a mammogram. This means that trying to find cancer on a young woman’s mammogram it is like looking for a polar bear in the snow.
As a result, mammography misses many cancers in young women.”
Guess what? REGULAR mammography (yearly after I turned 28) FOUND MY BREAST CANCER when I was 38. Oh WAIT. That’s TOO YOUNG to get breast cancer and it’s definitely TOO YOUNG for a mammogram to work.
And ya know what else? Even when I knew the lump was there, I never could FEEL it. By the time I could have felt it, I’d probably have been stage III or IV.
But I’m one of your “expendable” women – one of the “very few” who benefit from mammography.
Frankly, I think you’re foolish to exclude the growing number of women who are diagnosed with breast cancer under the age of FORTY (forget 50 for now, OK?). Diagnoses are being made YOUNGER and YOUNGER.
And yes – we do need better diagnostic tools, but right now mammography is all we have. And may I remind you that while increased surveillance for those with a family history is wonderful – that’s why I was on the mammogram train at an early age – 15% of breast cancers are hereditary, so 85% of those with breast cancer UNDER 40 have NO FAMILY HISTORY. What are THEY supposed to do? Oh. They can just wait until they’re 50 to go for a mammogram.
If they live that long.
This panel, and all who agree with the recommendations, have just signed death warrants for thousands of women.
Dr. Love,
A couple of problems with your analysis that are very disingenuous if not purposefully misleading.
1. You repeatedly state that the USPTF recommendations are based on evidence that shows no difference in outcomes for screening younger women. Stop saying this. We know from our own data, and most importantly, excellent Swedish data, that outcomes are changed to the benefit of younger women from screening mammography. Even the USPTF doesn’t claim what you claim- that outcomes aren’t changed.
2. You and the USPTF grossly exaggerate the harms involved. If, as the USPTF claims, it takes 1900 screens to save a life in the younger group, this equates to 190 women recalled for additional evaluation and a possible 45 minute biopsy (10% of those screened). Compare this to about 130 women subjected to additional evaluation and the associated anxiety and biopsies in the older age group (10% of 1300 per life saved). It is absolutely absurd to say that 60 more women on average subjected to a week or two of anxiety, a few of whom will have to undergo a simple office-based breast biopsy, is too much “harm” to save a younger woman’s life. It is so ridiculous that it reeks dishonesty.
Call it what it really is, and what the USPTF refuses to admit – a cost cutting strategy. I would probably even agree that the cost doesn’t equal the benefit if it comes to tax payers picking up the bill.
3. Everyone knows mammograms aren’t that great at screening young women and we need a better tool. The message from USPTF was to stop routinely screening younger women- not get a better tool.
4. You should start reasearching something other than ductal lavage. When has anything lavaged provided a sensitive screening tool? Poor premise from the beginning.
Dear Doctor:
I began my discussions with you on this site assuming you are a good professional with a heart to help women fighting this terrible disease.
Now after reserach your website and re-read all your comments, my opinions are changed. I think you are very ignorant in making irresponsive statements like mammography does not work for women in their 40’s and radiation may cause more cancers from screening.
Here are more questions to you if you have any answer (you have not answered any of my questions from before):
1. What your research foundation has done to help women? You have received donations and what new methods you have helped to invent to detect or treat breast cancers? From what I can find, nothing is the right answer;
2. Other groups like ACS and Komen foundations have promoted screening for early detection. It worked, as even the task force agreed in their reports, for women from 40 and older. I am pround of contributions to those organizations who truly care and know ehat they are doing;
3. What are exactly your motives? Do you want people to contribute more to your effort to find the cure for breast cancer? that’s fine but it does not make any sense for you to ask women to not take advantage of the best tools they have available today. Since you have nothing to help them today if the breast cancer is detected too late.
This is my last comment here to you. Please remember science and medicine are about common sense, open mind, and heart.
Thank you so much for this post. I have been shocked by the knee-jerk reaction the media is giving to these new guidelines. It makes perfect sense to me. My best friend had 2 biopsies (that proved to be nothing) in her 40’s due to false positives. My other friend that did find breast cancer due to mammography was 1) in her 50’s anyway, and 2) in the high-risk group (mother had breast cancer) so would have been screened in her 40’s anyway based on the guidelines.
I prefer not to expose myself to additional radiation, anxiety, and possibly additional invasive tests and now feel comfortable waiting until 50 for my next mammogram (I’ve already had 2 in my 40’s).
I wish people could step back for a moment and see how sensible this all really is.
Dr. Love,
After looking at my #4 posted, I apologize, I’m sure you dedicated a lot of hard work to your research and will continue to so and hopefully find a better screening tool.
One last thing though, I would be far more cautious about implicating radiation from screening mammograms as a harm. There is only evidence to show that the actual, realized benefit from the radiation is far, far greater than the theoretical harm.
I, too, am distressed by these new guidelines, because I know in my heart that insurance companies will use this “recommendation” to deny screening mammograms for younger women. Cancer is a horrendously expensive disease, and insurance companies are already using any excuse they can to deny people coverage, especially with pre-existing conditions. (There IS a reason there is a big debate on health care right now!) I am one of those “low-risk” women who was diagnosed with Stage 2 breast cancer when I was 39. I found the lump myself. Almost 5 years later, I am stage 4, but thanks to tons of research and newer medicines, I am continuing to live a full life. Can I also just say how very tired I am of the exploitation by marketers who cover their products with “pink ribbons,” so-called “fund raising,” which really means making tons of money for the company itself. It always comes back to money, to the bottom line. Dr. Love if you believe these recommendations won’t be used against us by the insurance companies, I agree with others who think you are mistaken and that you have underminded your own work.
The fact that MDAnderson stands by the previous guidelines says it all for me. I can’t be at SABCS this year, but wish I could to hear the ensuing debate with you about this and hear the scientists and advocates lambast this Task Force and your support of it.
This IS about rationing. For the meager 15 or 20% who the study(ies) claim benefit in their 40s from mammo, who could lose their life by waiting until they are 50, this is rationing. The technology is not that expensive and is an important diagnostic tool, though it is obviously not the be all end all. We do absolutely need more advanced diagnostics, but we are not there yet, are we? And until we are, we need to use every tool necessary to DX women as early as possible. I am 50, was DXed by digital mammo at 44. I am in a young survivors support group of over 250 women. 75% of them are in their 30s and 90% of those in their 30s were DXed BY MAMMOGRAM or DXed by annual GYN appt and confirmed by mammo followed up by ultrasound and biopsy.
I found my “lump” at 29. 1 year after the birth of my daughter. I then went to my GP. He dismissed it saying ” you r too young for breast cancer, lets keep an eye on it.” So I did. 7 months later it grew to the size of a large lemon! Very aggressive, Her2+ breast cancer. It was discovered by a mammogram. If I had not listened to that little voice in my head or better yet, the “new” guidelines……….I’d be dead. I bought your book when I was first diagnosed, now Im going to burn it. You have left a very bad taste in my mouth, you should be ashamed at you comments.
This report and the implications are devastating! Seven years ago my mammogram showed calcifications. I had a biopsy and experienced the “angst” that everyone is saying is such a problem. Five years later, at age 45, I was diagnosed with breast cancer that was found through a routine mammography screening. If these new guidelines had been in place, I would not have had either mammogram and I might have died of breast cancer.
Dr. Love,
#1 Please DO NOT insult us by starting your “dialogue” with mortality rates from papers SIX and TEN years old. This is BEFORE Herceptin and better homone therapies were in wide use. I know, Herceptin has saved my life, since I started on it when stage IV. One less number on the mortality rate.
#2 Tell us how you do not stand to benefit from a change in breast screening/diagnostic techniques when you/your research organization are the major force behind the Annual Intraductal Approach to Breast Cancer Symposiums?
The “intraductal approach” has not become mainstream. WHY? What is the holdup?
The 6th such symposium was held just Feb. of this year.
Perhaps by supporting the change in guidelines, which has caused doubt to be cast on all that was recommended before, you expect the door to open for new methods to be rushed out to fill a gap.
Sydney, would you feel the same way if one of the two mammograms you had in your 40’s showed you had breast cancer? As for your friend and her negative biopsies, I was told 80% of biopsies are negative, but I fell into the 20% that were positive. Do you think that means no lumps should be biopsied on anyone under 50 or better yet, abandon biopsies altogether? NO of course not! I can’t believe you can’t see how ridiculous these NEW guidelines are.Worse yet,I can’t believe Dr Love can’t! The new guidelines are one GIANT LEAP BACKWARDS for women!
Oh my gosh, I FINALLY get it. I’ve been reading about the new guidelines for 3 days now and just TODAY I understand what they were attempting to say about self-examinations. They aren’t saying to not do them, they are saying that any method you use is just as good as any other. So why in the world wouldn’t they just say those words? I think the entire problem here is that a bunch of PhD’s and MD’s do not know how to correctly communicate what they are trying to say to the rest of the world. Therefore, it’s completely misunderstood by everyone, and quite rightly so. If they were, in fact, saying that virtually nothing should change for women, then WHAT WAS THE POINT OF THE STUDY? The only point you can conclude on is that saying all this stuff will confuse almost every woman on the planet, AND cause insurance companies to act differently due to that confusion. Again I say – THIS IS A MESS.
Dr. Love,
I understand the reasoning for women in their 40’s, with no past family history or any other health risk rethink having a mammogram due to the dense breast tissue in younger women.When a women turns 50 due to menopause and age, her breast tissue is less dense and easier for a radiologist to read. If the mammogram is easier to read, why the guideline of every two years? I thank you for your continued diligence in fighting breast cancer.
Pam:
I’m not sure why you think I don’t think biopsies should be done, perhaps I was unclear in my comment.
Let me ask you a question. Why don’t we start routine, annual mammograms at age 30, or even age 20. I’m sure we could save at least one more life, right?
And to Christine, no one is saying if you find a lump you shouldn’t go get a mammogram–where are you getting that?
How many people died of false positives – oh maybe that’s a false death. As far as I can tell no one has died from anxiety.
Dr.Love,
I’ll tell you what anxiety is. It is being diagnosed with stage 4 breast cancer when it could have been caught at stage 1. Early detection is the most important tool right now in this fight, it gives us a chance to fight this disease. If I’m 44,no family history, doing no self-exams and not having a mammogram, how am I supposed to detect a breast cancer? Dr. Love can you please answer my question? I am very curious as to what your answer will be?
I was diagnosed with breast cancer when I was 47. It was found on my annual mammogram and was very aggressive. I had no family history and the lump could not be felt. I would not be here today if these new guidelines were in place 4 years ago. I rushed to join your Army of Women, and hope you will never send me another e-mail. I guess saving lives is not your goal.
Fiona
when i was diagnosed at 25 i had no history and no risk factors. under the new guidelines i would not have been screened. 9 months later my mother was diagnosed at age 78 because she had a routine mammogram. is it fair to my children to not have a mother or grandmother because they could not get a mammogram? would you want that for your daughter???
Sydney, I had my first routine mammogram when I was in my 30’s. Sadly someone I know passed away today from breast cancer. She was young,diagnosed in her 30’s, so excuse me if I don’t see where you are coming from. For the record, I didn’t say you wouldn’t approve of biopsies, in fact, I said of course you wouldn’t stop them. I was making a comparison of your thinking using statistics alone.
If we applied your thinking (and that of Dr Love) of not doing yearly mammograms in 40 year old women, and only start mammograms at age 50, based on the “fact” that a percentage of women will need further study, it is the same as saying don’t do biopsies on anyone under 50 because most of them turn out to be negative for breast cancer. You can see how ridiculous it would be NOT to do biopsies, but still you want to stop yearly mammograms for women in their 40’s because some women have results that, after further study, are found to be benign.
The fact that everything is based on women at “low” risk blows my mind too. Read through the comments on these articles, read comments on any breast cancer message board and see how many women were diagnosed with breast cancer who were LOW risk! I was considered low risk, I was diagnosed in my 40’s! No one in my family had any type of cancer before I was diagnosed. The point is, they don’t know what causes breast cancers so they can only guess at who is low risk. If they knew the causes, there would be cures.
I am sorry if your logic makes no sense to me!
Dr Love, where is the scientific study that supports your statement “In addition, the risk of the radiation is higher in younger women and cumulative so that the additional cancers caused by the radiation have to be weighed against the ones found by the test. It is not as simple as we would like to believe.”
No one EVER said the radiation from mammograms caused cancer! All we have heard for years is how low the amount of radiation is from mammograms and how it is even less with the new technology. How can anyone know a cancer was caused by radiation from mammograms, Dr Love? Where did you get that information from?
Dr. Love,
If mammograms done on young women “cause” cancer then anyone beofre the age of 50 should not get any radiation. No dental x-rays, no ct-scans, no Chest X-rays. All of the former emit higher doses of radiation than the current mammograms. Also no one younger than 50 should fly in a plane since you do get a small dose of radiation during each flight.
One other radiation source that should be removed. All of the radiation that is given to all cancer patients. We wouldn’t want to add to their cancers while curing them. Stop throwing the baby out with the bathwater. We have to work with what we have today and try to keep our collective heads out of our asses.
So as I asked before, why not issue guidance that calls for routine mammograms at 30 or at 20, why start at 40?
Dr. Love,
I think the saddest thing about this entire debate is that women don’t have any more real answers about breast cancer and how to detect it or cure it. How can I tell my daughter when she turns 40 not to have a mammogram when her mother found her cancer at 53 with no symptoms, no lump, and no history by a mammogram. Unfortunately it was stage three when they found it. I pray by the time she is 40 research will tell us what we need to know, but it certainly seems like that men now have so many tests and effective measures for their specific cancers, ie prostate cancer but once again women are behind the times and get the short end of the stick.
You said …These guidelines are just that—guidelines. Women under 50 who are high risk should have a more intensive screening program that includes mammography.
I say… We KNOW the guidelines influence people, doctors and insurance companies. The guidelines say only those at RISK should have mammograms before 50. Go to the boards to see how many under 50, NOT at risk (according to current guidelines) women had breast cancer and would have had much more severe treatment or died if they waited. I actually think the risk guidelines need changed (fertility drugs, family cancers in general – esp. colon, being thin premenopause, high estrogen, etc). But still many healthy, exercising, breastfeeding, vegetarians with no family cancers get it … look at the posts. Some cancers can’t be felt, some cancers can’t be seen, but the combination is what works.
You said … What they are saying is that a careful review of the scientific evidence shows that there is no data to support the idea that the benefit of mammography outweighs the risks for women between the ages of 40-50.
I say… Risks? How about the risk of finding your cancer late so you must endure chemotherapy, side effects from the chemotherapy for life, higher chances of it coming back, being stage IV with no cure, etc. Statistics can be sway to make a point. We all learned that in high school. Hear the voices of those who are living because it was found before they were 50.
You said… I am saying today: mammography is not a good tool for finding breast cancer in younger women. Yes, it is the best tool we have.
I say… Look at ALL the under 50 people with dense breasts it helped. Again, do you not hear their voices? It might not work great but as you said, we are not offered anything better yet.
You said … Young women’s breasts are more sensitive to low dose radiation and starting yearly mammograms at 40 will cause as many breast cancers as it will find.
I say… I don’t’ like radiation either but I don’t think today’s radiation is causing death but NO mammograms for those not in “risk” category will.
You said… The real issue is not whether mammography can find cancers but whether it can find them at a point that will make a difference in the outcome.
I say… Hmmmmm, at what point does it make a difference? When you can catch it early enough to avoid drastic surgery, avoid loosing your hair to chemo, avoid long term chemo side effects, avoid a young child losing their mother, avoid it coming back which causes death (these are things that cause real stress)! Yes, this is what early detection can do. What day exactly does it go from Stage I to II to III to IV? The answer depends on the cancer and that day is not known. OncotypeDX has enabled many to avoid these things. They talk about 5 year survival rates. That is not what they need to look at. We know that ER+ cancer (most common type) can come back many years (10) down the road. The higher the stage of cancer the higher the chance it comes back. There is no cure if it comes back.
You said… It is a complicated issue and we vastly over simplify it when we attribute all advances to screening.
I say… Advances in treatment come in to play AFTER screening / BSE. You have to find the cancer first. It is that simple.
You said…As to BSE, the studies are clear that women and find their own cancers but that it is usually not doing formal four position BSE but rather through the normal poking around we all do. What the guidelines say is that to have doctors teach formal BSE is not useful. They do NOT say “don’t ever touch your breast again”. Women younger or older than 50 who see or feel a change in their breast should have a mammogram or ultrasound so that the problem can be diagnosed. And no matter how old you are, you should see your doctor if you see or feel any changes in your breast.
I say… What I have read they said was “BSE are of no value”. If we are not taught (I was taught in high school) then how do we know what to look for? This is where you lost a huge support base. Depending on where the cancer is, it can be found easier by different methods. The BSE and / or mammogram has saved many under 50.
Why do you think we have become so vocal about this? It certainly isn’t selfish because the survivors have already found their cancer and we are high risk if we kept our breasts so we will get mammograms if needed. We are vocal b/c we have “lived” this hell. You don’t really “get” breast cancer until you have “lived” it. We want to protect womankind. We want to protect our families. These guidelines came to soon and were poorly stated. The tools are not good enough yet for this change. I believe that you want to help breast cancer treatment but I also believe your mind is not thinking clearly. I, and many others, are looking for a new leader of the research movement.
As another woman who was young (36), had extremely dense breasts, has no family history of cancer, no known risk factors, and had a “polar bear found in the snow storm”, I am horrified by these new “guidelines.” Mammograms saved my life. Eighty percent of women have no family history of breast cancer. So how can you determine who is at risk? To have breasts is to be at risk! Most women don’t know that, and rely on “guidelines” from people like you. And now, because of opinions like yours, countless more will die needlessly.
Dr Love – I’m so sad and outraged at your position with regard to these guidelines. They are a step backward in our fight against breast cancer.
The best thing we have today in the fight is EARLY DETECTION. Are mammograms perfect – no – are MRIs and ultrasounds perfect – NO. Cancers are missed, false positives are found … but you know what ? I sure wish my cancer had been one of the 80% of lumps that are benign. Unfortunately mine was Invasive Ductal Carcinoma – diagnosed when I was 44 by a routine (my first ever) mammogram. I did not have a lump that was palpable – it was deep in my breast – almost at my chest wall. I have no history of breast cancer in my family – but do have increased risk since I never had children and didn’t breast feed. I feel very fortunate that my cancer was found before it had spread to my lymph nodes or worse – to other organs. If I’d have waited until age 50 to have a mammogram who knows what stage my cancer would have been – it was grade 3 on the core biopsy pathology but grade 2 on the pathology from my lumpectomy.
I feel you’ve done a huge disservice to the breast cancer community – we do need better screening tools and even more so – we need a cure.
I no longer trust your opinions and will be removing my name from your Army of Women.
Dr. Love,
Thank you for making the complex understandable.
Please keep doing what you’re doing.
-Michelle
Breast cancer is obviously a very emotioanl experience for anyone touched by it. Emotions run very high and understandably so.
We all want to find out how it happens, how to detect it earlier, how to better treat it when it does occur and even find a cure!! I believe all of those things will eventually come, if the funding comes along for the ride.
That fight needs to be stepped up and maybe this controversy over the guidelines will step up the strategy to get there.
But what absolutely floors me is the raw emotions to the point of so many people who have made comments here and elsewhere that are so utterly filled with ignorance, mis-information, overly emotional reactions- a complete unwillingness or ability to look at the SCIENCE AND DATA- the actual evidence and studies of what has been done over the years.
I am just stunned at how so many people criticizing Dr. Love, who is such a hero in the field and partly responsoible for sooooo many women having their lives saved by her resource and wealth of caring information.
People need to get a grip on this issue and look at it from the sense in which it was intended: a public policy question!!!!
The same fear mongering is taking place that we have seen in the entire health care discussion and too many people are jumping on that critical bandwagon like a bunch of nasty robotic zombie-like ignorant mob maggots.
Are people really so stupid as to believe that those who look at the science of these studies and the very real data assoociated with it and support it, want women to just get cancer?
And to the women who are saying they will no longer be associated with the Army of Women- How utterly short-sighted and moronic!!!
That is as stupid as the Catholic Church saying they will no longer provide charitable and relief services to the poor and needy in Washington DC unless D.C. backs away from the right of Gays and Lesbians to marry. Yeah- they are actually making that threat.
For all the promise the Army of Women holds in fighting the BIG battle against breast cancer- those women should be ashamed of themselves.
Dr. Love- I- for one believe in the work that you do and the larger cause of finding the cause and eradicating the horror of breast cancer.
And for women who still want to get their mammograms in their 40’s- then get them.
I’m sorry Ron, and just when did you get your breast cancer?
Sign me ONE OF THE SHORT SIGHTED MORONIC WOMEN WHO HAD BREAST CANCER! Yes Ron, I am no longer a part of Arm of Women. I am actually a well educated woman with a background in science and worked over 7 years in research. Weigh your words more carefully Ron. Feel free to agree with Dr Love, but don’t call those of us who disagree names because we know the beast first hand.
The bottom line for me is that people who support the new guidelines are willing to give up my life to save the cost and anxiety of having mammograms for the other 1899 women in their 40s. I get that. I just can’t support it.
Dr. Love,
Thank you for having the courage to explain and support the guidelines as per the USPSTF. We do our patients a disservice by not explaining the limitations of all screening examinations well enough.
Dr. Love,
When I heard the new guidelines I was actually thrilled and relieved. As you know the U.S. Task Force always gave mammography screening a B recommendation. It is still B for 50 an over. As a health care professional (NP) and a women who had breast cancer 6 years ago, I am glad we can finally get away from doing the routine and look for real causes of breast cancer. For the first time I am coming out (admitting I had breast cancer, never considered myself a survivor, because I did not have a cancer that would have killed me-more about that later). What I see is that maybe many of us, have been over diagnosed, over-radiated, and over treated for Stage 1, that if left alone would not have harmed us. I now have a huge risk for later complications from the radiation, and multiple mammograms. In the u.s. we over diagnosed and over treated and women are still dying of cancer. Yes, there are so many women who have aggressive disease, at any age. These women need to know why they got breast cancer. For many of us, who caught it early, not convinced that the over treatment, is what will eventually harm us. All cancers are not alike or will they kills us. In fact they may go away on their own.
I applause Dr. Love. I remember and still feel guilty about all the HRT counseling I did as an NP, because I thought it was a good drug. After WHI, we now see how the medical field misled us. We need evidence based medicine. Dr. Love I hope there will be a clinical trial where women with early stage, could have a lumpectomy (with negative sentinal nodes, and clear margins) would be given the option to watch and wait. Any possibility? Also I’d like a clinical trial to see the harm radiation for 8 weeks on healthy tissue (tumor was .9 cm) has long-term. Why not 4 weeks, what’s the magic in 8 except for all tumor types. Doesn’t make sense.
Again, these screening guidelines will move us away from thinking screening cures cancer, it does not. We need to advance research. The insurance fear, I do agree with.
I hope other women like me who feel they were over-treated come out and speak out. For example, when recommended that I get on aromatose inhibitor because it would decrease my chance of reoccurence (not death, just reoccurrance) I did the math. My reoccurance rate was 7% without doing anything, 30% of 7% did not seem compelling enough, I did my own harm/benefit analysis. Women are being over treated. We need to learn more about types of cancers, and appropriate treatment. These new guidelines give women more control. This is a good thing. People are talking.
When I go to the dentist, my insurance doesn’t cover the $12 fluoride treatment. But I do pay the $12 and get it.
Many angry people wrote to say that they had a family history and/or a symptom and that they were outraged that they’d have to wait till 50 for a mammogram.
You have a history? Not routine. You have a symptom? Not routine.
I am stunned at the people who are turning their anger toward Dr. Love.
To all of the people who are screaming that this is not about science and even one life is worth it: where would you draw the line?
Should we screen all men age 40 and over? I’ve heard of men getting breast cancer in their 30’s. Should we screen all men age 30 and up?
There was a story in the news about very young girls who had breast cancer. Some without a family history. Should we screen all females age 8 and up?
I think most people would say that screening everyone eight and up is crazy.
So – where would you draw the line?
Where?
I’m not a doctor. I’m not a scientist. But, I know there’s no such thing as 0% and 100%.
We can not prevent all car accidents.
We can not prevent all airplane accidents.
We can not stop all disease.
Smart, well meaning people are working on the problem.
If you wouldn’t draw the line at eight years old – then YOU are saying that the life of that ten year old girl with breast cancer and no family history isn’t valuable.
If you’re angry at Dr. Love, where would YOU draw the line?
Where?
I agree that many are over treated. That has nothing to do with diagnosis and other guidelines can be used to change treatment.
We are emotional because we “get it”. The higher the stage it is found, the higher the risk it comes back and the more severe the treatment. There is no cure then and early death is the result. It is a step backwards plain and simple. You can find just as many studies to prove points on the other side. You can pick away at the studies and see how they got the results. They are not the “bible” or the “almighty”.
I’m all for “green and natural” and try to bring that into my life as much as possible but we need to look at reality. The science is not there yet. The death rate WILL rise if there are NO mammograms or so called valueless BSE under age 50.
Dr. Love:
You have hit the nail on the head. I think the very upsetting lesson we have seen manifested through the USPTF recommendations, is that health care reform will not happen (at least in the near future)- at least not “real” health care reform.
So long as politics and ancedotal rhetoric saturate the health care reform debate… the move towards evidence-based medicine, which is the foundation for controlling sky-rocketing costs, will never happen.
Thank you for your courage, your intellect, and your passion.
Maria, how can you be so sure that your cancer is not life theatening? During my journey with BC, I have met more women who were diagnosed with stage 1 in their 40’s and now they are in their 50’s and 60’s and wala it’s back with a vengence in their breasts and their bones now. I always ask lots of questions and most of them say they wish they would have gone through a more rigorous treatment at a younger age. Congrats on being a 6 year survivor, but your’e not really out of the woods yet, sorry to say. Remember people are not numbers, and as a nurse I have learned that in medicine you can never say never or always, there are exceptions to every rule. I don’t mean to sound cruel or to scare you, but if you can sit here and preach that an early stage IDC is 100% non-life threatening then you are giving many women a false sense of security and that’s just not right. I urge women to continue to listen to their oncologists who are the experts with regards to their individual treatments.
Dr. Love,
Thank you for being a voice of sanity, reason and compassion.
I’ve been shocked and disappointed at the backlash that greeted these new guidelines, which have been needed for so long.
Your comments on this blog and in news stories have brought reassurance and clarity to people who weren’t sure what to think. Please keep speaking up for what you know is right.
Dr Love
As someone who grew up in the UK where mammography screening begins at 50, I would like to point out that a positive effect of recommending mammograms to younger women is that it increases their awareness of the disease and the fact that it can hit younger women too. Many of my counterparts in the UK mistakingly believe that they have little or no chance of getting breast cancer in their 30’s or 40’s since the government does not recommend screening for their age group. I always admired the US for being at the forefront of the fight against breast cancer – now I am beginning to think they really don’t have a clue and that many lives will be lost as a result.
Lisa,
I agree with everything you have said. Stage I is different depending on the type of cancer. I didn’t have IDC. So treatment needs to be indivualized to the type of Cancer. Some cancers caught at Stage 1 are very aggressive and need to be treated. Other cancers are not. There are no guarantees. I am Nurse and I have no guarantee that the treatment given to me was appropriate. I believe that is the point. Women have to ask questions and make sure they are getting the appropriate treatment. It’s a personal decision. I was able to discuss my options with my oncologist. Sorry, I don’t consider my self as a survivor. I’d like to think of some Cancer’s as a chronic condtion. I feel like I was diagnosed with a condition that probably was not life threatening. Radiation however, has major risks. So more studies need to be done. All cancers are not the same. We need to learn more. I know many women who chose mastectomy without radiation, and are fine 20 years later. More research. To be honest, I would be handling my cancer quite differently if it has been aggressive, etc. Thank you for you comments. People are talking, that’s excellent. What I don’t want are people to have a false sense of security because they get mammograms every year. We need to find out why women get mild non-aggressive tumors verses the one you describe in your note. We are all different. However, the treatments are the same. I found my experience with cancer and the treatment prescribed quite primitive. Six years later, if I would get another occurance, I would do it differently–No radiaiton. If I get cancer in the same breast again, and it is a different type of cancer, I will never know if it was the radiation or true reoccurance. This is my experience, my opinion. We need to learn more from other countries, where they have more data and evidence on screening guideline.
Maria -
Just curious about the 8 weeks of radiation as breast cancer treatment you mention. I had 6 weeks for a very aggressive cancer, and have NEVER heard of anyone getting 8 weeks worth.
Yes, my cancer came back. I had 8 of 18 nodes positive and 5 were basically all cancer when removed.
Also, the idea that statistics from other countries can apply in the USA I don’t find valid. European countries are where I assume you are referring.
They are by far smaller in area and population, and I think the general quality of the doctors is higher than the average here.
I know France the best. I have friends there who have been getting breast MRI for as long as 8 years. These gals are thought to be high risk for some reason and the system there can afford to screen them that way. I had MRI of my breasts at a teaching medical center once my cancer was diagnosed, and the surgeon whated a better look. At age 50 I still had sense breasts. Another In Situ was noticed just prior to the surgery.
I wish there was a better way to screen that would be fair to all who need and want it. But, I have not seen anything new offered after all this commotion was caused by the announcement that what we now have does more harm than good.
I am horrified by the attacks on Dr Love, who has my support for her rational stance. Dr Love, thank you for helping me understand the new information. I am a fan of your book, read cover to cover, and passed along to my sister and friends with breast cancer. I appreciate all the information on your site.
It’s complex, folks. No easy answers, no silver bullets. Each woman needs to weigh the tradeoffs of “routine” mammograms and make her own decisions. The controversy has been out there for some time, but most women don’t know that. My nurse-practioner was shocked when I declined a “routine” mammogram last check up — she wasn’t aware of the harms: not only the cumulative radiation, but that the severe squeezing may spread an otherwise slow-or-harmless tiny cancer. If you are the woman harmed, that’s not a “trivial statistic.” Science evolves, recommendations change. We need to be flexible, active students of the science, not passive consumers. Whose body is it, anyway? And whose responsibility?
I myself choose to take the less-is-more route. Over-medicalization is real, very harmful, and I have experienced more than I care to recount — including a pointless “baseline” mammogram at age 26 (the point was making money for the doctor and clinic).
Why is there no outrage over the toxic stew of synthetic chemicals and radiation that causes so many of our cancers and saturates modern society? Why is prevention not taken seriously? Where is the anger over the lack of funding for women’s health, so that we have to hold bakesales and fun-runs to support basic research? Why is flawed mammography the “best” that can be offered ? Where is the research to let physicians tell the difference between small cancers that won’t do any harm and those that will become destructive?
Meanwhile, don’t shoot the messenger.
I was diagnosed 4 years ago with high grade, invasive breast cancer at 43. No family history — no risk factors. Based on these guidelines there would have been absolutely no reason to think mammography was necessary. However, I can see now if these guidelines were in place 4 years ago, I’d most likely be dead by the time I reached my 50th birthday. But thats OK, right, because statistically, I’m just one person and a very small “blip” on the statistical radar. Comforting. Very comforting.
I am a young woman with an elevated risk for breast cancer and I commend you for your work and for making so clear your highly rational perspective.
I am currently living with another form of incurable cancer. I understand well the desire to hold on to the hope that our current tools for early detection will work. It is very scary when science tells us that these tools don’t work as we hoped. But the reason we raise money for scientific research is so we can trust scientists like yourself to guide us. I’d rather be lost in the forest for a little while longer while we try to find a new path than spend my time stumbling down a road which has shown to be a dead end.
Your honesty and clear thinking is very comforting during this time of upheaval.
Best,
Kairol Rosenthal
Author of Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s
Dr. Love is telling it like it is about mammograms whether it is popular or not. Thank you, Dr. Love, for your honesty, concern, and dedication! It really bothers me to see her dissed and her motives impugned.
How many women have had total mastectomies and chemo for conditions that might not have troubled them ever, especially DCIS? How many women knew they had breast cancer years before they needed to with no difference in the result? Yes, some women have their lives saved, but many fewer than imagine they have.
The humanistic position is to let women choose based on good information and their values. Yes, I agree there should be insurance coverage. But insisting on insurance coverage is very different from insisting on a biased and harmful official recommendation to always go get a mammogram — when following such recommendations in fact causes MANY very real harms.
The USPTF Task Force recommendations are sensible, excellent, and long overdue.
read Susan Sommers new book… Knock out… Read Secret History of the War on Cancer by Devra Davis – BE YOUR OWN HEALTH ADVOCATES.. Mammograms are not the tool that they should be. BRCA2 gene owner who happened to have breast cancer.. no “survival” – its gone and Pink nauseates me! PREVENTION IS KEY.. not more drugs, not more radiation…
Thank you for standing for what is right. Thank you for telling the truth. The response is how it was with AZT and . People were screaming for it even though it was proving ineffective and harmful. They still wanted it.
Dr. Love,
I understand what you are saying. I wish the energy and force women are expressing was directed towards better screening and even (dare I say it) PREVENTION of breast cancer in the first place.
I was diagnosed with breast cancer last year. I was religious about mammograms and thought even though my breasts were dense, that a “clear mammogram” meant I was okay.
I was not okay! The tumor was over 6cm and was NOT seen on screening mammogram, diagnostic mammogram, or on ultrasound. But, by the time it was this big, we could feel it.
I was SHOCKED to find out that women with dense breast tissue are 5x more likely to get breast cancer, AND that our standard screening (mammograms) do not work well at all on dense tissue.
I felt, and still feel, betrayed by mammograms, and by our society that led me to believe if I had a clear mammogram, that I was okay.
YES, we need something else.
I’ve since had a bilateral mastectomy because I did not trust that my “hard to manager” breast tissue could be managed successfully.
People in the news are very focused recently on “false positives”. I say posh. What about FALSE NEGATIVES???
Thank you for all you do.
I GET IT.
Beverly
As a family physician licensed to practice in both the United States and Canada, I always questioned the recommendation to routinely screen women in their 40’s. That has not the recommendation in Canada, where screening mammograms are recommended at age 50. I have always told my patints about the risks and benefits of mammogram screening and encourage them to come to the decision that best suits them. And the same is true for my recommendations about PSA testing for men. Some people want all the information they can have as early as possible, and others don’t want any testing that is not absolutely proven to have benefit. I enjoyed reading the copy of Virginia Ernster’s article on the 1997 guidelines fiasco. Dr. Ernster was my epidemiology professor at UCSF and one of the most thought provoking teachers I met there. I appreciate your stand on making good recommendations for screening based on science, not fear. Keep working for prevention, that’s what will utimately save the most lives. Mary Boegel, M.D.
Dear Susan, I do appreciate all you do as you have been the fighter for breast cancer in America. I do want to say that I missed my mammogram in 2000 I was 52, my last mammogram was in 1999 I just miscalculated. In 2001 I was diagnosed with Brest Cancer had a needle biopsy, lumpectomy, 11 nodes removed, a second surgery to remove more cancer, chemo and radiation. That year they announced on the news women did not need to get mammograms too. They may not be the best way but it’s all we have now, a false positive is better than cancer. I disagree on some of these issue, due to my circumstances. Keep up your good work I do appreciate all you do. Rose
Susan, you were my doctor before you left UCLA, and I’m hugely proud of everything you’re doing. Here’s what I don’t understand, and it actually has nothing to do with you, except that you haven’t, to my knowledge, ever promoted this concept.
I believe that women with dense breasts should be pointed away from mammograms, and given the options of ultrasounds or MRIs, instead.
Nothing is perfect, and there is certainly the chance that ultrasounds or MRIs can miss tumors. But my own experience, and the experiences of every woman I met during treatment whose cancer was discovered late, was that their tumors, no matter how big, did not show up on mammograms. In my case, the tumor was over 3 cm. and had already metastasized. Even at that size, it didn’t show up on a mammogram. But as soon as an ultrasound was done…bingo.
Women with dense breasts should be separated out of the population that receives mammograms. Even if there is no research to back this up, ask around. Ask women who were diligent about mammograms, but their cancers were missed until, like me, they found it, themselves because their breast didn’t look right. I’ll bet you pretty much anything that those women had dense breasts.
I forgot a point that I think is important to consider. I don’t think it’s an accident that this news about breast screenings comes during the national ” discussion” about health care. Insurance companies are spending $1 million per day, to keep health insurance the way it is. This news about breast screenings – and now PAP tests – is being labled “Obamacare”, further frightening people about rationing of health care. THERE ARE POLITICAL MOTIVES TO THE PUBLISHING OF THESE FINDINGS!
If it walks like a duck…
Dr. Love; Five days after my 40th birthday in 1995, my gyn found a lump in my breast while showing me how to do a BSE. Fortunately, the tumor was benign. Fast forward to March, 2009, as I was doing my monthly BSE in the shower–I found another lump in the same the breast. Only this time, I wasn’t that lucky. I was diagnosed with Triple Negative Breast Cancer, a particularly agressive form of BC, as I hope you and your readers know.
Interesting note: less than five months earlier, I had a CLEAN mammogram. My first mammogram after my discovery of my TNBC showed a second tumor growing, which also biopsied for TN. What shocks me is the blithe recommendation that women just not do anything until “the guidelines” tell them to. If I had not been doing my BSE, the gods know how bad my cancer would be and how much lower my chances for survival might be. For the record, I am a healthy, 54 year-old Yogini, vegetarian, non-drinking/non-smoking with NO family history of breast cancer. If I were younger and followed these guidelines, I’d probably be dead. Mammograms may be debatable based on scientific evidence, but a BSE SAVED MY LIFE, or at least help extend it. And I find it unforgivable that the “experts” are telling us to abandon them. I guess my life doesn’t mean much to “the experts”. I saved my own life with a BSE, and I am forever grateful that I took the time that month, as I had for the past 14 years, to do a BSE.
How does one get off the list for Army of Women? I asked to have my name removed and I just got another survey sent to me! I want NO part of a movement which will result in the death of more women.
Dr. Love,
Could you clarify exactly what a “slow growing” cancer is? The report does not make this clear. I was diagnosed with non-invasisve DCIS at age 57, having had annual mammograms from the age of 40. If I had chosen not to have mammograms, would this have been a cancer that “might never have killed me anyway”? After three excisions, including an open biopsy, my surgeon was still unable to establish clear margins. After reviewing all of my personal risk factors, I decided to have a unilateral mastectomy. With the new guidelines and your own remarks regarding the panel’s findings, I question the reliability of mammography readings on the other breast, and now worry about increased exposure to radiation even more, especially after nearly 20 mammograms in my lifetime. If non-invasive DCIS were found, would its slow growth rate not really be a strong risk factor for a woman my age, which is now 58? None of this has been made clear in recent days. Could you clarify for women in this position?
Thank you for opening up this dialogue.
Marie
Dr Love,
I appreciate all you have been doing to find a cure for this disease. My mother found her breast cancer via self exam, it did not show up on the mammogram or ultrasound due to dense breast tissue.
Unfortunately, she went through a living hell trying to survive and ultimately passed away at age 55. That was 12 years ago.
Today, I am in my mid forties and considered high risk. I appreciate having a screening tool such as mammography however imperfect it may be. I am concerned by your position on the new guidelines. I fear these new guidelines will lead to insurance companies denying women the only screening tool they have aside from BSE. I don’t understand why you would support something that might result in increased deaths from this disease. I read your comment about radiation from mammography in women under 50 causing as many deaths from cancer as it saves. Could you please elaborate on this and cite some research for me? If this is the case why haven’t we heard about this before?
Thank you for having the courage to speak your mind. I’m sure you knew that many would disagree. I think folks aren’t connecting enough with the fact that as many cancers are caused by the mammograms as are caught. That’s a big deal. My DCIS was caught and treated at age 46 but I’m guessing that the outcome would have been the same if it was caught at age 50. I think the problem is that the statements emphasize the ‘inconvience’ of false positives and really that’s only an issue for the insurance companies. We would rather be safe than sorry but most of us don’t realize that mammograms can cause cancer. I’m still with you because I trust you to say what you believe even when you know folks disagree. You’re my hero! Thanks.
Dr. Love,
What are you thinking? 70% of detected breast cancers are in women with no family history. My biggest regret in life is skipping my annual mammogram at age 44 only to find at age 45 that I had three areas of DCIS and one very messed up area of ductal carcinoma (stage IIIB). I couldn’t care less that I lost my breast but wish it was caught earlier. There was a lump and I should have been more savvy about it. That was ten years ago. A mammogram at 45 saved my life and had I had one a year earlier instead of at a two year interval I may not have required the neo-adjuvant chemo, radiation and adjuvant surgery. I had multiple nodes at all three levels including the third level apex node. I am very fortunate to have been super estrogrn positive and that is how we are controlling my disease. Suffice it to say these guidelines don’t cut it. Your foundation is the last organization I would expect to support them. Thank you.
How can we question Susan Love’s commitment to women and to fighting breast cancer? I hate to say it, but the American public cannot deal with nuance. The task force was simply being honest; there are no definite fixes for breast cancer and screening overpromised and has not delivered. I applaud Dr. Love as many before me for her courage in saying what needs to be said. Having just joined the long line of false positives, bizarrely a few weeks ago during pink month, I have done a 180 degree turn in how I view my options for my body. So no, I’m not counting on mammography to save my life. And as far as BSE, Dr. Love states unequivocally in her book that it’s fine to be familiar with your breasts on a regular basis rather than making a once-a-month appointment with them. I’ve always felt intuitively this was true and I check them every day when I soap up in the shower—if there’s any lumps, I hope I’ll find them, and I know the monthly changes they go through because I feel them every day. I’m an R.N. and worked for 17 years as an operating room nurse and I can tell you that nothing is certain in medicine, and positive outcomes are never guaranteed. Someone is going to figure out a better way to discover breast cancer that will make mammography obsolete. Until that day, the guidelines say to me that I didn’t need 21 mammograms since age 30 but going forward this is something I can discuss with my doctor, weighing my options. I agree with Kairol’s eloquent message that she’d rather stay lost in the forest for awhile longer rather than going down a dead end road. In the New York Times today, Dr. Robert Aronowitz (UPenn) says, “You need to screen 1,900 women in their 40s for 10 years in order to prevent one death from breast cancer, and in the process you will have generated more than 1,000 false-positive screens and all the overtreatment they entail.” Some of that overtreatment wasn’t just a few extra mammograms and biopsies-some of it was surgery and radiation and yes, even chemo. Let’s understand the limitations of mammography, demand researchers to work to find a better way to diagnose it and ultimately, find the cause of breast cancer. But don’t blame our good and steadfast advocate, Dr. Love. Carry on marching, Army of Women.
Dear Dr. Love-
Thank you for taking a stand on this extremely important issue, and for the work you have done over the years. I am a BRCA1+ breast cancer survivor who discovered my rapidly growing tumor by ‘poking around’. Oddly, it never showed up on a mammogram. I was also an epidemiology graduate student at UCSF, where I first heard about the BRCA (breast cancer) gene. Without that knowledge, I would never have even known about BRCA and would not have asked to be tested after my diagnosis. Knowledge is power. My concern is that too many women (and doctors) become dependent on modern technology. A little common sense and my two fingers told me something was wrong. A mammogram told me nothing.
Thank you for pointing out the issue of the danger of repeated exposure to radiation for younger women. My own doctor has been the only person to bring that up in discussions of when and how often to get mammograms. He was sensitized to the issue because his mother-in-law died of breast cancer that he thinks was caused by radiation.
Do you actually have a number (per thousand) for breast cancers probably caused by annual mammograms between 40 & 50?
Dr. Love,
Don’t you really think that more education about contributing factors to getting breast cancer and the fact that digital mammograms detect cancers in denser breast better should have been the message from this board? As many other who have responded to your support of these guidelines, I am fighting breast cancer. I discovered a lump in my left breast 10 and 1/2 months after my last mammogram. The next morning when I contacted my physician, the first words out of his nurse were, “We can’t order another mammogram, it has been less than a year. YOur insurance won’t pay for it.” Before I could think of a response which would not offend her she came back with, “Oh, you had a thickening, we can order a diagnostic.”
Needless to say that doctor no longer treats me. I was 63 at that time. I had no family history of breast cancer, was a nonsmoker, exercised on a regular basis, and drank no alcohol. Even though I had my yearly exams, I had stopped doing those BSEs that I had done faithfullly as a younger woman. I had become complacent because of no family history that everyone talks about. I wasn’t supposed to get this.
From the information that I received following my diagnosis of a 3 cm tumor on top of a 5 cm DCIS, I learned that dense breasts often are often one of the warning signs. I also learned that 85% of women diagnosed with breast cancer have NO FAMILY HISTORY.
I have the very aggressive HER2+ breast cancer. And that relatively small 3 cm tumor had already spread to all 21 lymph nodes under my arm. Thankfully, it had not spread to my bones or any other organs and I was able to get into a phase II study at Mayo Clinic for Herceptin and Tykerb inconjunction with regular chemo and radiation treatments.
I have a 40 year old daughter, and YOU don’t want her to get mammograms because she might worry? I hope you can sleep at night knowing you are condemming MANY women, young and older, to their deaths!!!!
I certainly agree with most of Dr.Susan’s views. Mammography is one of the dangerous tools to diagnose breast cancer. The exposure to radiation cumulatively can cause cancer. Therefore, it is best used where it works – women above 50. Thanks to Dr.Susan to clearing up the things.
I just donated to the SLRF because I trust Dr. Love’s hard work, experience, candid talk , intelligence & compassion. Thank you for dedicating your life to finding a way to put an end to breast cancer.
Dr. Love, you better start working on that “better way” quickly because I don’t think you’re going to be selling near the books you use to. Sorry but I find some of your remarks just plain ignorant. To be honest, when I was diagnosed stage IV, 4 years ago, I bought your book and put it down because if I had taken what your outdated book had said to heart, I’d already be dead.
My daughter died at 28 years of age due to invasive breast cancer. She tried for a whole year to get a doctor to order a mammogram to no avail. They said she was to young to have cancer. When she finally had outward signs of breast cancer a mammo was ordered. Had she been given the mammo when she needed it a year earlier would she have lived longer than three years?
When we discussed chemo with her doctors they said the chemo is so toxic it often causes other cancers in the body. She developed cancer in her spine and brain within a year of the chemo treatments. So by this new logic we should stop chemo because it causes more cancers and does more harm than good, it’s not worth the risk.
The insurance companies will stop paying for mammograms for women under 50 and over 75 due to these new “guidelines”. If you think other wise you are sadly mistaken. This will hinder proper care for women and our health has been neglected for far to long as it is.
If mammograms can cause cancer, than I have two feet in the grave because the radiation they used to “cure” my cancer burned me so badly that I had jelly bean size blisters on the top of my breast and the entire skin of the underside sloughed off. The pain was excruciating and they had me stop at day 21 for two weeks to heal enough to continue. That is the radiation I am worried about!
By the way, from Dr Love’s own book, page 125, “Radiation Risks” “Most specialists now feel that the radiation risk of mammography after age 35 is negligible or non-existent.”
Every time I think I have put my cancer behind me, a study comes out to make all the emotions surface again. I don’t know what to think or who to believe now. This is the last time I will visit Dr Love’s web site, I would never be able to trust what she has to say. Her book is going in the trash where it belongs.Sometimes ignorance is bliss.
In April of this year I had a mammogram. The radiologist saw 5 calcifications (digital mammo)and recommended a biopsy. My mammogram one year earlier was “clean”. I was found to have stage 0 DCIS. Lumpectomy and radiation followed. So… this would be categorized as early detection. I read Dr. Love’s book, read all the research I could find and made the most informed decision I could based on evidence-based medicine. Indeed, at a recent talk given by Dr. Love (AARP convention) – she stated that “slash, burn and poison” is still the best we have and she would undergo the process. What would have happened if I had to wait another year before another mammogram. No one really knows, but then why are so many apparently intelligent people willing to recommend that I should “wait and see”. Here are my 2 cents worth from the reading I’ve done the past few days.
1. The members of the USPSTF did not include a medical imaging specialist or a breast cancer oncologist – but did contain a children’s Dr., Ph.D.,RNs, and several Drs. with apparent health insurance affiliations.
2. Breast cancer is the 2nd leading cause of cancer deaths in American women with 192,000 new cases and 40,000 deaths that will occur this year.
3. Mortality rates have been decreasing over the last 20 years and this is attributed to early detection and treatment.
4. Recommendations advise talking with one’s clinician. About what I ask? How will the determination of “high risk” occur? Since the annual mammogram will be taken away, should we then test every newborn for the breast cancer gene so that we can know the risk category. One only has to read this and other blogs to see the number of “low risk” women that developed breast cancer.
4. I am very concerned about the heartlessness that is becoming the modus operandi of human decision making. We appear to be making life decisions (who lives and dies) based on percentages and statistics (”There are lies, damned lies, and statistics” – Mark Twain) as opposed to value for each life, compassion, empathy, heart-felt judgements.
5. Those who write position statements offer statistics that support their conclusions, but do not site the statistics for the other claims they make. For instance, why has no one over the past couple days offered data on how many women object to the anxiety from false-positives, how many women die from the anxiety of false-positives versus those that have undiagnosed breast cancers? How many cancers occur from mammogram-induced cancer or radiation therapy induced cancer?
6. Supporters of the new guidelines state that women can still get mammograms (radiated) if they want to. C’mon. Let’s be honest and real here. If these policies are adopted by insurance companies (and I’ll bet that they do), then only the more wealthy individuals will be able to afford them. Once again, we will have policies that exclude those without money from life-saving procedures, and the number of “those without money” that may die from breast cancer will probably increase.
7. According to the American College of Radiology, the mortality rate of breast cancer has decreased by 30 percent since the onset of scheduled yearly mammography screening implemented in 1990. A reduction of deaths caused by breast cancer that remained unseen for 50 years preceding preventative screening.
8. I am so very saddened by the heartlessness that seems to be increasing in society. Perhaps each person should in the next week count the number of women in their 40s and 50s that they encounter and walk up to them and try to explain to them why their one life (of 1900 in their 40s, or of 1300 in their 50s) is not worth spending money to save.
IF anyone gets down this far I hope this post gets heard. Both the new mammogram and PSA screening guidelines dance around the mantra that we have had for decades in healthcare: “early detection=cure”. This mantra came out of new ways of treatment that could save lives where in the past people equated cancer with death and it was a stigma not to be mentioned in society. After much research we know more about cancer, and it is complex. Some cancers are “aggressive” or “poorly differentiated”. They started that way, they will end that way, and no matter how early we catch them they will prove fatal. Cancer in not a monolithic disease, it has various causes and patterns, even when found in the same tissue. I have patients coming in with hemorrhages in the brain that are probably metastatic disease, but we never find the primary because it is too small and asymptomatic. Despite some notable advances, like the treatment of ER breast CA, we are still left with a short of tools that devolve in a slash and burn technique. People started SBE with huge amounts of money and effort poured into the campaign. It made sense when we were trying to prevent women ignoring it until their cancer had eroded through their breast tissue and had external sores, but no one ever researched it’s ability to prevent deaths until recently. In retrospect no doubt more lives would have been saved if those precious 2-5 minutes of teaching were spent on education about cardiac risk factors and prevention of diabetes. The road to hell is paved with good intentions. I’m sure the 1/3 of parents who babies died of SIDS would love to have their children back if we had bothered to do the research earlier about putting babies to sleep on their bellies (like was recommended in all hospital nurseries) vs. their backs. I work in trauma, and we are just starting to realize all those pan CT scans we do on the off chance that they might pick up some injury that a good clinical exam didn’t reveal CAN and ARE doing more harm than good in the average 20 something care accident victim. (The difference is the trauma surgeon won’t be the one diagnosis the lymphoma in the future, so the causal connect won’t be hitting him in the face.) The movement towards evidenced based practice is difficult, with false starts, and much emotion. I really hope all the truly angry posters here can come back after time and rethink this issue.
Dr. Love,
I am a fan of your books, knowledge and scientific explanation of the issues. I am a 3 year breast cancer survivor and your “breast” book made my journey easier. I was wondering if the use of digital mammography changes the data on results in younger woman. I have heard that it reads dense breasts better?
Dr. Love,
I thank you for your years of advocacy and research on this disease. While I understand and agree that decisions about preventing and treating health issues must be informed by science, when it turns out that you are that one life that is saved it is difficult not to say “who cares about statistics – we should do whatever it takes.”
My cancer was found on a routine mammogram when I was 43. I had no risk factors, very dense breasts and in fact no technician, surgeon or oncologist was able to palpitate the tumor even after it had been confirmed by the biopsy. The tumor was small but it was a grade 3, triple negative cancer and I already had some node involvement. All my doctors have told me that my prognosis would have been drastically different had this cancer not been detected when it was.
So as imperfect as mammography is – and I agree with you that we must always be searching for better detection and prevention methods – if you are one of the ones under 50 for whom it was truly a lifesaver these new guidelines may make you feel as I do – that my life is expendable as determined by the current statistical data.
Thank you again for all you do, these are not easy discussions or decisions.
As a woman under 50 who was diagnosed with stage 3A breast cancer that was missed on a mammo I was OUTRAGED by the new guidelines! But,I must admit, Dr. Love’s article cleared up some of the controversy for me. I too feel that we need to come up with better tests for early detection and risk assessments. I do not have any family breast cancer history nor do I carry either BRCA gene mutations. I do know that an MRI would have found my cancer, but I didn’t fit any criteria to warrant such a test. I have invasive lobular carcinoma grade 3 which is one of the nearly undetectable on mammography until a more advanced stage. Also, it wasn’t a definite mass to palpitate. An ultrasound showed the lesion, however, my Dr. chose to rely more on the mammogram. My hope is that we don’t revert backwards and deny the awareness that we have embraced as the army of women united in our cause!
I wasn’t going to come back to this site but I want to let women know they can support women’s rights to have mammograms in their 40’s regardless of whether they are high risk or not by signing the petition at Susan G Komans site.
http://www.komenadvocacy.org/takeaction.aspx?id=92
I signed it. There are still people willing to advocate for us!
Dr. Love:
Thank you so much for trying to introduce some rationality into this highly emotional topic. It is frightening to me that so much time, effort and yes, dollars, are directed toward diagnosis and treatments that do not improve overall outcomes. Many can provide anecdotal evidence to support their opinion, but few have the will and interest to examine the data to see what it really says. Keep up the good work.
Is thermography a viable alternative?
Thank you for putting evidence against political expediency. And while you’re at it, why not remind people who push those five year survival rates that surviving five years from date of diagnosis is fairly meaningless, if two of those years are simply extra time you know you have cancer, with the same final outcome – people seem unable to grasp that. I have at least two friends who died of breast cancer who are part of this 5 year “success” statistic, because one died six years after diagnosis and one after seven years. Maybe some day someone will even have the nerve to say that women over 50 might be perfectly rational if they decided that a risk benefit analysis didn’t support mammograms in their individual circumstances.
Well, in my case mammography certainly has not proved to be the best method for early breast cancer detection. I had my mammograghies regularly since I was very young and was always told that I had very dense breasts. Unfortunately, by the time a doctor finally suggested I have an ultrasound and then biopsies done on lumps that had been palable for years, four tumors totaling 7 centimeters where found. Of course I had to have a mastectomy and my lymphnodes taken out at that point. I feel I wouldn’t of had to have such radical treatment if the mammographies hadn’t been depended on so much. Mammography is limited and unable to differentiate what is necessary to detect breast cancer. It should not be depended upon solely for breast cancer detection.
And how long does it take a doctor to explain to a woman how to do a self breast exam? Four minutes? The task force could not possibly be recommending against it to save doctors more time to see more patients to make more money at the end of the day, could they?
…or COULD they??
Maria, thanks for your response to me, you cleared up something really important. You actually had stage 0 dcis which is different than what you originally stated as stage 1 BC. Several years ago they were treating dcis with chemo and they do not anymore. We are making strides in treatment and in the case of dcis women are not being overtreated as they used to be. I wish you well and hope you never have to go through being diagnosed with IDC. It’s hell.
Readers, as a woman diagnosed at age 45, I want to say please consider going to breastcancer.org and participate in their petition against these guidelines.
It seems a lot of women are diagnosed with DCIS on a baseline mammogram. Dr. Love, could you weigh in on this? That’s what happened to me, and I wonder whether I should have insisted that we just do another mammogram in 6 months or a year to determine whether there were any changes. I ended up with a lumpectomy for low-grade DCIS right before the first NY Times article came out about the changes to the mammography guidelines. Talk about a Kafkaesque existence. Did I have cancer, or not?
what do you think of a blood test looking at Vitamin D levels in younger women? If the D falls, you get screened. Seems to be a relationship between D levels and the onset of breast cancer. Thanks for your information.
Dr. Love
I have supported your Army of Women and have tried to get as many people to join as possible. I was selected to be on the Today Show with you, but the producer decided not to use my interview. I believe in you, but cannot believe that you are siding with the task force on the new guidelines. I am deeply disappointed.
I was 49 when I was diagnosed. I started regular mammograms at age 35 because of dense breast tissue and cystic breasts. My doctor recommended this because he could never tell a benign cyst from a tumor merely by palpation. I was in great health ,at optimum weight and had no family history of bc. Those factors mean that I was at low risk for developing breast cancer, yet got it anyway. Under the new guidelines, if I had waited for the age of 50 for that fateful mammogram, I would have been diagnosed with stage 3 bc instead of stage 1 and perhaps not have survived. Worse yet, I may never have gone for that mammo since I was in the low risk group. My tumor was not palpable as it was deep and near the chest wall. If it wasn’t for that mammo, I would never have known. I don’t think we can decisevly determine which people are at low risk. BC is a beast and there is no telling with certainty whom it will strike.
Yes, perhaps all the radiation I have been exposed to since my baseline at the age of 35 was responsible for the breast cancer in the first place, but if it weren’t for that mammo at age 49, I would never have known about it at all.
How about thermography vs mammography? With complex breasts, I have chosen to get both thermography and utltra-sound for the past 3 years – even though I end up paying out of pocket as thermography is not covered at all by insurance. It seems to me that there are other safer and earlier detection modalities that are not being seriously considered, studied or covered by the mainstream medical community and media.
Well, I was 45 when I was diagnosed with Stage II breast cancer. It was 1.1 cm. VERY SMALL. I would have never found it without the mammogram. If I had waited till I was 50 to have that mammogram, that lump would have been huge, and would definitely have been in MORE THAN 1 lymph node. I have SEVERAL friends in the exact same situation. Insurance companies will definitely use these “guidelines” to deny women under 50 this test. It’s not right.
Why SHOULD insurance pay for routine screening?
It shouldn’t!
If I have breast cancer and the cost of my treatment is impossible for me to pay – then my insurance should pay.
How did we get away from doing things this way?
How do we get back there?
Unfortunately mammograms are not great, but they are the BEST tool we have at the moment. I found my DCIS completely by accident when my son hit my breast while we were playing. I found a lump after feeling latent pain and a mammogram detected calcifications. I was fortunate enough, at 36, to have found it when we did. I could well be the poster child for early detection… It is important to remember that Susan G. Komen was in her 30’s when she was diagnosed and died of breast cancer. It is in HER name that the most money for research and awareness of the disease have been raised. A YOUNG woman, not the TYPICAL breast cancer patient, was the catalyst for a tremendous movement in education and research. Is this irony lost on everyone but the young survivors? We are not an insignificant statistical footnote.
In resppnse to Pam from Nov. 20 Nov 2009 at 5:42 am
To Pam- You may think you are well educated with a background in science (curious what kind of science that would be) and that you did research (whatever that means).
I know the beast first hand also Pam (despite your arrogant assumption that I do not!!)
And- if you are as educated as you say you are and have chosen to drop out of the Army of Women with the wonderfful work that that is all about simply because you do not understand Dr. Love’s well educated position on these guidelines- simply because she has a reasoned believe in what is really important in all of this- then I will re-state my earlier comments. Yes- that is absolutely short-sighted and very MORONIC!!!! VERY!! That is not name calling- that is your state of mind! Think about what that position means Pam. Totally pathetic!
I was not high risk. At 41, a mammogram detected calcifications which led to the finding of DCIS..which led to an MRI that detected invasive cancer. It was caught at Stage 1, but you can’t convince me that my DCIS was not dangerous and my tumor was not growing. I was spared chemo and possibly my life because of my routine mammogram. Work on perfecting the screening instead of taking away whatever screening (albeit imperfect) we have!
To Patty Vivo-Aucoin
Doesn’t your story back up Dr. Love’s point?
1. You found your DCIS. It wasn’t found by routine, screening mammogram.
2. Since it wasn’t invasive and may never have become so – this is a topic Dr. Love and others have spoken about as well. (Not saying you shouldn’t have been treated – I would have too. Just pointing out that medicine doesn’t know what to do with DCIS yet. So, we treat it.)
Furthermore,
I didn’t count, but many of the angry responses have come from women who found their own cancers and didn’t find them on routine, screening mammograms before age 50.
Many of the women who have written angry replies who were diagnosed before 50 – even if a mammogram was part of the process – it was not a routine, screening mammogram. They had a family history.
You guys are making Dr. Love’s point.
Dr. Love, my mother is a breast cancer survivor whose cancer was found at age 50 on her first mammogram. That said, I completely support your position and am sad that so few women understand the rationale behind it. Healthcare should not be about knee-jerk one-size-fits-all treatment, it should be about individualized approaches, and irradiating a woman’s breast annually when the likelihood of finding a malignancy is so small just doesn’t make sense (and, full disclosure, I’m 43, so I’m in that population that is no longer recommended to have mammograms yearly). While I do agree that it’s likely the insurance industry will use this as an excuse to deny benefits, isn’t one of the problems with our healthcare system that it’s OVERUTILIZED so much that the funds to offer services to everyone just aren’t available? I hear the people who state that one life lost is one life too many, and I agree–but mammography isn’t what is saving those lives (and if it’s promoting cancers, it may actually be COSTING them).
My concern is the guideline that women over 50 have mammograms every other year. I am now 64 years old and have had routine yearly mammograms since age 50. I have no cancer of any kind in my family. At age 61 during a routine mammogram and ultrasound a tumor was found. After PT/CT scans I was diagnosed with Stage IV Her2 Positive BC with five nodes affected besides the breast tumor-two on my liver, one under my arm and two near my breast bone. Now three years later, having undergone chemo and contining infusions of Herceptin every three weeks I am cancer-free. If I had waited two years before my next mammogram, I don’t believe I would be here writing this. This guideline is just wrong and many women could end up in the same position as I was. I was lucky in that I did have yearly mammograms and my cancer was found while it was still treatable.
To Responding~
Actually, no. I had had a baseline mammomgram the year prior (at the same facility) which had been clean. After finding the DCIS, I had genetic testing and was found to be BRCA+ which put me at higher risk for both breast and ovarian cancer. Would you care to take that gamble with your life and assume that the DCIS which showed up within less than a year would not have been aggressive and turned invasive? I seriously doubt it. Some may call it overtreatment, but hey, at least I’m here to raise my kids. At the last NBCC conference there were discussions about how scientists cannot yet biologically distinguish between the turtles (slow growing/nonaggressive cancers) from the bears. In my case, digital mammography on very dense breast tissue detected a cancer at the earliest possible stage that it can be found. I think it is good that we found it early! I realize that the annectdotal evidence from young survivors is “inconvenient”, too bad.
Dear Dr. Susan, I pledge my full support and understanding of this unfortunate misunderstanding, which I think was heightened given that breast cancer is a disease most trimmers not only for the patient who suffers but also for society that accompanies it. In the experience of our Cancer Institute in Guadalajara, Mexico, the incidence of breast cancer is very high in patients younger than 40 years, with the youngest patient of 14 years to which treatment was given in September last . The idiosyncrasy of our women have made their diagnosis is in advanced stages by the lack of knowledge, learning of self-examination and medical misinformation that some very young ages is sought as a means of diagnosis of mammograms, and given that most of the teams that we are not digital, and breast tissue of a young patient is so thick, are made dx and false negatives. It needed at least in our country, a culture of self-examination, the training of all medical staff for valuation and that valuations have become even gynecologists, where his exploration is far from satisfactory. It is important that patients know that there are methods that can diagnose breast cancer even earlier than steppes of mammograms and self-exploration, such as ductal lavage and ductoscopia. Perhaps if these methods were more widely disseminated, this overvaluation of mammograms as only diagnostic method for breast cancer in early stages has not been widely accepted or assumed such dimensions. Dr Love, I regret now unpleasant is happening, you who have given their lives for the diagnosis and eradication of this disease, I know that is the guardian angel, and would be an honor for me and a great joy to have a contact with you as for me and my patients, it is necessary to use these new methods diagnsoticos (well not so new, but if not widely) in order with this go by our statistics, and gradually locatd the age for the taking the 1st and subsequent mammograms. It is necessary to get a ductoscopio (new, used, borrowed or otherwise) to initiate study protocols in our population, so we would appreciate you communicate with me to take hard work of early diagnosis and prevent women from suffering is stres know they can leave their young children alone, I beg.
Women who have written to Dr Love esterno I beg your descepcion think 2 times, if someone who has dedicated his life to help achieve a foundation of research, education about a disease that affects women, for diagnose it early, against the large pharmaceutical industry on multiple occasions were affected by their decisions, reviews, books, research, would the hands of others for what he has fought. Just appreciate what you have done for years, I understand as a mother, daughter, sister, friend of someone with breast cancer, but not blind us what was given as information only, the decision remains ours. It is insurance from the U.S. who will feel fully supported by these new guidelines, but please investigated and ductal washings for ductoscopia now know that not only may request a diagnostic study of cancer but a study diagnosis of premalignant .
Dr Ana Lilia Lopez Aldrete adiestrmiento in Mastologia gynecologist.
Guadalajara Jalisco Mexico
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Dear Dr. Susan, I pledge my full support and understanding of this unfortunate misunderstanding, which I think was heightened given that breast cancer is a disease most trimmers not only for the patient who suffers but also for society that accompanies it. In the experience of our Cancer Institute in Guadalajara, Mexico, the incidence of breast cancer is very high in patients younger than 40 years, with the youngest patient of 14 years to which treatment was given in September last . The idiosyncrasy of our women have made their diagnosis is in advanced stages by the lack of knowledge, learning of self-examination and medical misinformation that some very young ages is sought as a means of diagnosis of mammograms, and given that most of the teams that we are not digital, and breast tissue of a young patient is so thick, are made dx and false negatives. It needed at least in our country, a culture of self-examination, the training of all medical staff for valuation and that valuations have become even gynecologists, where his exploration is far from satisfactory. It is important that patients know that there are methods that can diagnose breast cancer even earlier than steppes of mammograms and self-exploration, such as ductal lavage and ductoscopia. Perhaps if these methods were more widely disseminated, this overvaluation of mammograms as only diagnostic method for breast cancer in early stages has not been widely accepted or assumed such dimensions. Dr Love, I regret now unpleasant is happening, you who have given their lives for the diagnosis and eradication of this disease, I know that is the guardian angel, and would be an honor for me and a great joy to have a contact with you as for me and my patients, it is necessary to use these new methods diagnsoticos (well not so new, but if not widely) in order with this go by our statistics, and gradually locatd the age for the taking the 1st and subsequent mammograms. It is necessary to get a ductoscopio (new, used, borrowed or otherwise) to initiate study protocols in our population, so we would appreciate you communicate with me to take hard work of early diagnosis and prevent women from suffering is stres know they can leave their young children alone, I beg. Women who have written to Dr Love esterno I beg your descepcion think 2 times, if someone who has dedicated his life to help achieve a foundation of research, education about a disease that affects women, for diagnose it early, against the large pharmaceutical industry on multiple occasions were affected by their decisions, reviews, books, research, would the hands of others for what he has fought. Just appreciate what you have done for years, I understand as a mother, daughter, sister, friend of someone with breast cancer, but not blind us what was given as information only, the decision remains ours. It is insurance from the U.S. who will feel fully supported by these new guidelines, but please investigated and ductal washings for ductoscopia now know that not only may request a diagnostic study of CANCER but a study diagnosis of PREMALIGNANT . Dr Ana Lilia Lopez Aldrete adiestrmiento in Mastologia gynecologist.Guadalajara Jalisco Mexico
Dx. DCIS at age 43 just like so many other women commenting on this site. It is clear that mammograms save lives, but I guess only the lives of women who are 50 and older are worth saving??? I am aware of the false positives, negative bxs., dense breasts…so what!?! Now check the health care reform bill section 27 13. If it is passed as is, watch what happens to breast cancer related deaths and/or % of advanced stages at intial diagnosis. If performing mammograms inflicted clinically significant harm to women ages 40-49, I could understand the “recommendation”, but the recommendation itself will do more harm than good. As for comments regarding ultrasounds and MRI’s being more effective than mammograms for diagnosing breast cancer- that is false! My DCIS was seen only on digital mammography! If I had to wait until age 50, my diagnosis, treatment, and prognosis would have been VERY different…in a bad way! Until something as good or better is readily available to replace mammography for 40-49 year old women, then I speak from experience…GET A YEARLY DIGITAL MAMMOGRAM LADIES…. AND TELL ALL YOUR FRIENDS TOO!
Hi Patty Vivo-Aucoin,
Yes. I agree. As I said in my previous post – I think you did the right thing to treat your DCIS. I would have done the same thing. And that was before I knew about your BRACA positive result!
The part I wasn’t clear on and I’m still not clear on is the role that the routine, mammogram played here.
You were diagnosed at 36? Younger than 40. Therefore, you couldn’t have been getting a routine, screening mammogram. You were following up on a symptom or you were high risk because of a family history or there was some other reason that you were being tested at that young age.
Therefore, if I understand all that you’ve said as well as the mammography guidelines we’ve been discussing: 1) yes you are the poster child for early detection and 2) the guidelines we’re discussing don’t apply to you because you weren’t diagnosed as the result of a regular, screening mammogram and you would have been tested anyway.
Yes?
Thank you for being so clear about the new recommendations. I read the recommendations and some of the references and related articles, but things that you posted really clarified things for me.
I feel the press has done everyone a diservice by focusing on the ‘no routine mammograms’ instead of latching onto the fact that mammograms don’t just find the aggressive cancer. Why isn’t the press asking a better test? All I’ve seen in the press is ‘not everyone has to have a mammogram’. If this recommendation does anything, it should be that women demand a better test. That women demand to be looked at and treated based on who they are and their history.
I am disappointed in the government backed report and in your comments on the matter. Screening is just that, a screening. I have spoke to physicians and the radiation in breast mammographer is small and it would require hundreds to equal the radiation from a chest x-ray. Mammogram screening has saved lives. Prostate screenings have saved lives. I wish they had a way to screen for lung cancer. My Dad, a non-smoker died a year ago. By the time they found the cancer it was stage 4 and not treatable for any success. He accepted that and died within 2 months. Screenings work.
Dr. Love,
Do you believe the LCIS I was just diagnosed with (at the age of 50) was caused by 10 years of mammograms?
I was 48 at DX from annual mammogram- I have NO RISK FACTORS, NO FAMILY HISTORY. Stage I, Low Oncotype, No Chemo, just lumpectomy and RADS. Frame it any way you like, blame politics of the 90s, backtrack on what you didn’t say, but the bottom line is you ARE saying that its AOK that I wouldn’t be diagnosed for another 2 years- sentencing me to chemo at the very least and more likely death. I have a 21 month old baby. I have noted your peculiar recommendations before, but came to believe that the great part of your work justified my belief in you as a sanguine resource. No, it is NOT acceptable that I should suffer for your nihilism. YOU’RE DISTRESSED???? We’re supposed to worry about YOUR DISTRESS when you casually assign the worst distress possible on me? I can not contain my anger. I reject you completely. But hey, it doesn’t matter to you, right? Because according to you, I’d be dead now or too sick to fight you. And that wouldn’t be distressing for you.
This response is to Melissa. How do you know that your DCIS would have progressed? I, too, was diagnosed with DCIS in my 40s and I consider myself exactly the woman who would be “saved” by the new guidelines. There is absolutely no evidence that DCIS that is left untreated always progresses to invasive cancer. You should really take a look at the USPSTF report to see what it says about DCIS. Having just had surgery, the report makes me sick. Rather, the fact that several doctors who treated me did not acknowledge the controversial nature of DCIS makes me sick.
Here’s something to think about. How are other non-invasive, or pre-invasive cancers treated? Skin cancer, the deadly kind, for instance. If you have a pre-invasive skin cancer, or even a stage 1 skin cancer, you have an excision and frequent follow-up. No radiation, no toxic drugs to make sure you never get it again. Why do we treat breast cancer so differently?
My mother was diagnosed with breast cancer in 1979 at the age of 52. She died three years later of metastatic disease in her bones and brain. I was diagnosed with Stage IIB, ER, one positive lymph node, in 2006 at the age of 42. What amazed me was that my doctor told me that it appeared that my tumor had been there “for about 7 years.” I had two mammograms in the time period. Most survivors I have talked to said they were told their cancer had been there anywhere from 10 years to 3. Clearly we need an earlier detection method. I heard Dr. Love on NPR in October of 2006 stating that “by the time a cancer shows up on a mammogram it has been there anywhere from 10 years to three” Why don’t more women know this? We would be fighting for true early detection, a blood test or something similar. If I had known this, I would have known that my mother’s cancer started in her early 40’s putting me at much higher risk and perhaps I would have had an MRI and found my cancer earlier. In my 20’s I was told by several doctors that because my mom was diagnosed at 52 – supposedly post-menopause, I was not at high risk. I now know she actually would have been diagnosed in her 40’s today. Where are the statistics on how many women are diagnosed at the time of their FIRST mammogram? Or how many mammograms did a women have prior to diagnosis? This could be answered with a survey. I have to assume my Mom never had a mammogram prior to diagnosis, would she be alive if she would have? I have often wondered if my mammograms contributed to the growth of my cancer. This is a complex disease, many questions still to answer. Now, more than ever, we need the Army of Women and better research on the causes of breast cancer. It is being diagnosed in women younger and younger, I have three young daughters and a son and I am gene positive. I NEED answers. Are these women being diagnosed in their 20’s and 30’s also being screened? How many of those diagnosed in their 20’s and 30’s had mammograms? My guess is not many but if it is a large number than maybe there is evidence that mammograms can contribute to the cause of breast cancer in young women. Where are these studies and why aren’t we answering these questions? These new guidelines are very confusing and unclear, but don’t kill the messenger. Dr. Love has been the only one to speak out about the fact that most breast cancers start years prior to being diagnosed via mammogram. If I had known this in my 20’s I might have had a different outcome. We are not getting all the facts, Dr. Love is trying to shed more light on the issue. We need to lobby for more funding of MRI’s in high risk women. So much to do, now is not the time to turn your backs on the Army of Women. Let’s not ignore the elephant in the room – what environmental or chemical development has so drastically increased the number of breast cancer diagnoses in recent years? That is what we need to know. BSE and mammograms are all we have now and the guidelines should reflect that they should be done with the understanding that we need something more conclusive. I agree with the what about thermography questions? We need a funded study for that.
Very disappointed with your stand on mammography screening. My mam at age 41 saved my like.
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My understanding is that early mammograms are primarily to establish a baseline against which changes can be detected and monitored – they don’t really expect to find cancer in a 40 year old, although of course sometimes they do.
Also, the “if you want an exam in your 40s you can still get one” comments are disingenuous. Tell someone they are “low risk” in one sentence and ask if they want a mammogram in the next. Not going to happen. Most people have heard that if their relatives had breast cancer, they are at higher risk. Very few people have heard that most people with breast cancer have no family history of it.