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!

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162 Responses to A Message from Dr. Love about the New Mammography Guidelines

  1. Marie says:

    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

  2. Tiffany says:

    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?

  3. Rita says:

    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.

  4. Cakky Evans says:

    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.

  5. Nancy Thomas says:

    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.

  6. Dr. Norah Schwart says:

    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.

  7. Judy Okamura says:

    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?

  8. Sandra Jones says:

    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!!!!

  9. Ragha says:

    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.

  10. Sue LaVaccare says:

    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.

  11. Sherry says:

    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.

  12. Sharon W says:

    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.

  13. Pam says:

    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!

  14. Pam says:

    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.

  15. nancy says:

    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.

  16. Jeanne says:

    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.

  17. Yvette says:

    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?

  18. Susan Lovelace says:

    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.

  19. Judy Veron says:

    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!

  20. Pam says:

    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!

  21. sam kelley says:

    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.

  22. Norma says:

    Is thermography a viable alternative?

  23. Harriet says:

    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.

  24. Sharon G says:

    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.

  25. Tracey says:

    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?

  26. Tracey says:

    …or COULD they??

  27. lisa says:

    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.

  28. Kim says:

    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.

  29. Jenny says:

    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?

  30. Gail says:

    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.

  31. Miriam says:

    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.

  32. Donna says:

    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.

  33. Cecile says:

    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.

  34. Broken System says:

    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?

  35. Patty Vivo-Aucoin says:

    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.

  36. Ron says:

    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!

  37. Helene says:

    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!

  38. Responding says:

    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.)

  39. Responding says:

    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.

  40. Beth says:

    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).

  41. sandy says:

    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.

  42. Patty Vivo-Aucoin says:

    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.

  43. Dra Ana Lilia López Aldrete says:

    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

    Proponer una traducción mejor
    Gracias por proponer una traducción al Traductor de Google.
    Sugiere una traducción mejor:
    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

  44. Melissa says:

    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!

  45. Responding says:

    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?

  46. Karen says:

    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.

  47. Michele says:

    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.

  48. Lori says:

    Dr. Love,
    Do you believe the LCIS I was just diagnosed with (at the age of 50) was caused by 10 years of mammograms?

  49. Rachel says:

    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.

  50. Jenny says:

    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?

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