Local Voices Support Large Study's Recommendation on Mammograms at 40

Recent trends in breast cancer detection have wavered. To perform breast self-exams, or not? To get mammograms, or not?

The worry about breast self-exams is that they may skew results into too many false-positive tests. Some who recommend fewer mammograms have suggested that over-screening leads to unnecessary invasive tests and undue anxiety.

The American Cancer Society declares on its website: “If you are a woman and age 40 or over, you should get a mammogram every year.” They state that “recent evidence has confirmed that mammograms offer substantial benefit for women in their 40s.”

A major study presented at the 2011 Breast Cancer Symposium of the American Society of Clinical Oncology also overwhelmingly supports these preventive measures, and suggests the continued importance of self-exams and annual mammography in detection, even in younger women.

“An analysis of breast cancer diagnosis data from nearly 6,000 women in Michigan suggests that mammography and self-breast exams remain important tools for detecting breast cancer, even among women aged 40 to 49 for whom routine mammography has been questioned by the U.S. Preventative Services Task Force (USPSTF)," states a release dated Sept. 6, 2011, from The Breast Cancer Symposium. The USPSTF recommends generally that women get mammograms every two years beginning at age 50, but notes that screenings should be determined on an individual basis.

“While there has been ongoing debate about when and how breast cancer screening should occur, this study validates that women who undergo regular mammography screening present at earlier stages and often require less aggressive treatment than those who do not,” said Dr. Jamie Caughran, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, Mich.

Caughran, who helped lead the research team for a recent study on mammography, said women age 40 and up should use both methods for detection. High-risk patients should seek advice from their doctors about the age for and frequency of tests.

Dr. Kristen Zarfos, Medical Director of the Comprehensive Breast Health Center at St. Francis Hospital in Hartford, speaks about the importance of early detection whenever she has the opportunity. The USPSTF recommendations, she said, “were not based on new data. They were computer analyses, not based on clinical data.”

The critical group that could be negatively impacted by the USPSTF recommendations, in Zarfos’ opinion, is women between ages 40 and 50. “Some say that mammograms are not effective for women in that age group because they have dense tissue, but data from multiple studies concludes that there is a 25 percent survival benefit for women who have mammograms between ages 40 and 50.”

Zarfos recommends that women have mammograms based on the recommendations of their own physician, subject to the American Cancer Society guidelines. She also recommends yearly breast exams for women of all ages.

As for the issue of self-exam resulting in unnecessary stress and testing, Zarfos said, “My opinion is that all women should know their breasts – the appearance and texture – and the best way to do that is through monthly self-exam.”

West Hartford resident and breast cancer survivor Kim Green would agree. “The most powerful weapon a woman has is knowledge of her own body. Being in my early 30s and not a candidate for a mammogram, I did self-exams on the 30th of each month. At age 34, and 6 months pregnant, on Memorial Day weekend, I did a self-exam in the shower and found a lump. It was cancer, but here I am 13 years later still surviving! Early detection ... life saver.”

At the end of the day, women need to be responsible for their own health, if for no other reason than it’s the best gift you can give to yourself and your family,” Zarfos said.

The Michigan study, completed this year with data from nearly 6,000 women with breast cancer, also contains these other findings:

• Breast cancer in women younger than 50 was more likely to be detected first by feel than by mammography. Of the women whose tumors were found by feel, 40 percent were younger than 50.
• Overall, 65 percent of the breast cancer cases were detected by mammography, while 30 percent were detected by feel and the other 5 percent by other methods.
• For women diagnosed with breast cancer before age 50, 49 percent of the cases were detected by mammogram. Of those, 18 percent were Stage 2, and 4 percent were Stage 3.
• For women diagnosed with breast cancer before age 50, 46 percent of the cases were detected by feel. Of those, 50 percent were Stage 2, and 17 percent were Stage 3.
• For women over 50, 81 percent of breast cancers are detected through mammography.

In 2011, ASCO predicts 230,480 new cases of breast cancer for women, 2,140 for men, and 57,650 non-invasive cases. About one in eight women will develop breast cancer, according to ASCO.