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The Telegram
  • Second opinion: Mammograms a useful tool but just part of prevention

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  • It’s one of the most hotly debated issues in health care. A large part of the medical establishment agrees with the traditional and long-held view that women over 40 should get an annual mammogram to screen for breast cancer. But some question the tests, when to get them and their limitations. The debate has been ongoing for 20 years.
    On average, mammography will detect about 80 to 90 percent of breast cancers in women without symptoms, said Dr. Debbie Saslow, director of breast and gynecologic cancers for the American Cancer Society.
    There is some disagreement among doctors about how many lives are saved, when to start mammography and how often to have it, but nearly all experts agree that mammography saves lives, Saslow said.
    Dr. Marissa Weiss, medical director of BreastCancer.org and director of breast health outreach and breast radiation oncology at Lankenau Medical Center near Philadelphia, agrees: “Annual mammograms starting at age 40 are the best way to catch the disease early and improve your odds of beating it.”
    A three-pronged approach
    Considered safe and reasonably accurate, mammograms have been in use for more than 40 years. Basically, it is an X-ray of the breast that doctors use to evaluate, diagnose and follow people who have had breast cancer.
    Experts advise a three-pronged approach to breast health: mammograms, clinical breast exams and breast self-awareness, said registered nurse Stephanie Martin, a patient navigator with Piedmont Newnan Healthcare’s Cancer Wellness programs, located near Atlanta.
    “By the time you reach your 20s, you should be having an annual clinical breast exam by your medical provider. Once you turn 40, annual mammograms are encouraged. These tools are important for detecting abnormalities at their earliest state,” Martin said. “Breast cancer can take years to grow before someone could actually feel it themselves. This is why it’s important to use more of your senses to detect a problem. ... Feel for it with breast exams (breast self-exams and clinical exams) and look for it, using mammography, ultrasound and your own two eyes.
    “Breast cancer has over a 95 percent cure rate, but early detection is key.”
    While state-of-the-art mammography technology is constantly improving, “mammograms are not perfect. They are simply the best we have right now,” said Andrea Rader, manager of communications for Susan G. Komen, the United States’ largest breast cancer awareness organization.
    Women need to be aware of the limitations of mammograms, said Karuna Jaggar, executive director of Breast Cancer Action, a grassroots education and advocacy organization.
    “There is the limitation of overdiagnosis or false positives where some women will be called back to find out they don’t have a problem, leading to anxiety,” Jaggar said. Others will undergo a few biopsies before doctors can be sure of a diagnosis.
    Some breast cancers will not be found on initial screenings, and screenings mean exposure to a small amount of radiation.
    Page 2 of 2 - “But be assured, mammograms combined with good treatment save lives,” Rader said.
    Benefits vary
    Mammography is the most effective breast cancer screening tool used today, but the benefits vary by age, according to the Komen website. Not all the main organizations agree completely about when to start getting mammograms, but they are very close.
    For women 40 and older who are of average risk for breast cancer, the American Cancer Society, the Mayo Clinic, Komen and the National Comprehensive Cancer Network recommend a mammogram every year. The National Cancer Institute recommends mammography every one or two years starting at age 40. The U.S. Preventive Task Force recommends “informative decision-making with a health care provider from ages 40-49.”
    Women at higher risk of breast cancer may need to be screened earlier — before age 40 — and more often than other women, said Rader. Factors that increase risk include the BRCA gene mutation (the gene that can produce hereditary breast and ovarian cancer); a strong family history of breast cancer, such as a mother or sister who has been diagnosed; a personal history of breast cancer; and previous radiation treatment to the chest area as a child or young adult.
    If you’re 40 or older and have an average risk of breast cancer, experts agree yearly screening mammograms should be part of your health care. If your breast cancer risk is higher than average, you should talk to your doctor about a more aggressive breast-cancer screening plan that makes the most sense for your situation.
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