CNN News recently reported on new breast cancer screening guidelines by the American Cancer Society and other health organizations.
Dr. Connie Hernandez
The new guidelines have many women feeling confused and angry – especially women over 40 and breast cancer survivors.
Let’s first the issues, and then I’ll suggest a reasonable path to evaluate your breast cancer risk.
- First, there’s a great deal of confusion about the age at which women should begin getting regular mammograms. Should they start at age 40, 45, or 50? The guidelines from three respected health organizations are mutually contradictory – the recommended age depends on which organization you ask.
The American Cancer Society now says less screening for breast cancer is better – women should start screening at 45 instead of 40, and they can skip routine manual evaluation performed by their doctors. This guideline has caused a furor among breast cancer survivors and others who are concerned that women who delay screening may have their cancers diagnosed too late.
The problem arises because these three highly respected groups recommend different ages for starting regular mammograms: American College of Obstetricians and Gynecologists (age 40), American Cancer Society (age 45), and U.S. Preventive Services Task Force (age 50).
- Second, mammograms can save lives, but they can also cause harm – by exposing women to unnecessary radiation, and by false-positive findings that require painful biopsy.
What should you do? Again – it depends on which health organization’s advice you choose to follow, because each organization evaluates the pros and cons of mammograms differently.
- Still not feeling confused? The rate of false positives for women under 45 is especially high, because they have denser breasts, so tumors are harder to spot on a mammogram. The American Cancer Society is concerned to protect women from painful and unnecessary breast biopsies. Some women have false positives year after year, causing unnecessary pain and emotional distress.
When the federal Preventive Services Task Force declared, six years ago, that women in their 40s didn’t need regular mammograms, it evoked a wave of outrage. As CNN reported, “Younger women whose breast cancers were caught by mammograms angrily responded that they would have been dead if they’d followed that guideline.” Thus the American Cancer Society now says it’s okay to get mammograms in your 40s, if you choose, so long as you understand the risk of false positives, and that the mammogram may find a small tumor that will go away on its own, but that the physician will almost certainly want to remove “just in case.”
CNN concluded: “Since doctors can’t reliably discern the harmful from the harmless cancers, they treat them all. This means some women are getting potentially harmful treatments, such as radiation, chemotherapy and surgery, when their tumor would never have caused a problem.”
Dr. Connie’s recommendations for breast cancer screening:
For years, it’s been clear that mammograms are of limited value for women with dense breasts. For several years now, California has required a disclaimer to be added to the mammogram report indicating that results are, in fact, inconclusive when breasts are dense.
The breasts of most younger women are quite dense, so extending the grace period (the number of years for which annual mammograms aren’t recommended) to age 50, as recommended by the Preventive Services Task Force, makes sense. Repeated exposure to radiation is known to be carcinogenic, so why needlessly expose these women?
Having said that, we must agree with the American Cancer Society’s emphasis that women in their early 40’s should be allowed to get mammograms if they understand the risks of radiation and the inaccuracy of the findings, including false positives.
We at Pacific Naturopathic believe that doctors should educate their patients about the further options available to them, and that patients should be allowed to choose their path.
These options include breast thermography, which we use at Pacific Naturopathic.
Whether medical insurance will pay for alternative screening choices is another question. Insurance companies are all too eager to drop benefits when possible, and they’re not at all ready to accept reasonable non-conventional alternatives.
Meanwhile, it’s unfortunate that there’s no way, other than biopsy, to discern whether a finding is a false positive or a true concern.
What about thermography as an alternative to mammography? Although thermography may report suspicious findings that can only be diagnosed conclusively by biopsy, a unique benefit of thermography is that it can safely and painlessly track physiological changes over time. The advantage is that thermography can identify false positives without the need for a painful biopsy.
For example, if a suspicious area continues to “heat up” on the thermographic scan, a reasonable diagnosis would be inflammation or some other pathology that deserves serious concern. But if it cools down, whatever process may be happening is obviously waning, and while it may deserve further monitoring, it should be of lesser concern.
Keep in mind that we’re talking about whether women should schedule routine annual mammograms, and if so, at which age they should begin.
The women that we feel should be advised to seek further anatomic imaging (mammograms) for clarification are:
(a) Women with BRCA genes
(b) Women with palpable lumps
(c) Women with increasing thermal risk ratings on breast thermography, over time.
For these at-risk women, ultrasound is the least invasive choice, and evaluation by mammography and MRI are other options.
Please phone us at (650) 917-1121 for more information about the adjunctive cancer therapies we offer at Pacific Naturopathic.
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