There is public uproar and protests from the medical community against the US Health and Human Services Department about the recent guidelines issued by the US Preventive Services Task Force (USPSTF), an outside consultant “group of experts who make health recommendations based on best available evidence,” which call for women “to start mammogram every-other-year screening for breast cancer at age 50 unless they are more comfortable with starting earlier.”
This was a change from the annual screening starting at age 40 recommended by the previous guidelines. If the new guidelines are officially adopted, women who are younger than 50 opting to have a screening mammogram will not be covered by their health insurance.
The change is “ill-advised and dangerous…and a step backward and represents a significant harm to women’s health,” according to the American College of Radiology and the Society of Breast Imaging. The two associations claim that the new guidelines will lead to “countless unnecessary breast cancer deaths each year.” They advocate the return to the former guidelines: annual screening starting at age 40 and starting at age 30 (or earlier) for higher risk women.
The USPSTF countered that “to extend the life of just one woman, 1,904 women ages 40-49 and 1,339 women ages 50-59, must be screened.” While statistics show that breast cancer risk rises sharply at age 40, the USPSTF “calculates that breast cancer risk gets large enough by age 50 to justify the ‘potential harms’ of screening,” referring to anxiety over false positive results and painful unnecessary biopsies.” The radiology societies argued that “the risk at age 40 already justifies such harms,” and that “at least 40% of the patient years of life saved by mammographic screening are of women ages 40-49.”
The American Cancer Society “still stands by its recommendation of routine mammogram and breast cancer screening for all women at the age of 40 and above…and performed every two years.”
What is mammography?
A mammogram is a low-dose X-ray examination to detect any abnormality in the breasts which may not be noticeable with the naked eye or by palpation (manual feel). A 20-minute radiological test, a mammogram usually takes about 20 minutes. Since this is a low-dose radiation exam, the exposure is not even part of the debate. There are two types of mammography: screening and diagnostic.
How do they differ?
Screening mammogram is done as a routine exam, a preventive measurer, to check for any abnormalities in women without symptoms. Diagnostic mammogram is performed when symptoms of breast cancer are suspected. This test takes longer and the patient is exposed to more radiation since more films are taken to check more views of the breasts for more accurate evaluation.
What are some signs of breast cancer?
One should be suspicious of any change in the shape or size of the breasts, or the consistency of the skin, when it feels thicker than before, or the presence of pain or discharge from the nipple. This is where familiarity with your own breasts is important, the reason why awareness and or a weekly self-breast exam is of great value.
When should awareness begin?
Starting at the age 20 or even sooner, women should be aware and familiar with how their breasts look and feel, whether they are symmetrical or not, of same size or not, how their nipple and areola (circumferential surrounding area around each nipple) look like. These are then the normal baseline from which any changes may be detected. Not all changes mean they are abnormal. The best thing to do when a woman suspects any abnormality in her breast is to seek medical consultation. As a matter of fact, even without symptoms, it is recommended that women have breast exam every 3 years as a part of a periodic health exam.
What is the incidence of breast cancer?
The incidence of beast cancer in the United States is about 13%, or one in 8 women. In 2009, about 192,370 cases of invasive (wild and deadly) breast cancer and 62,280 new cases of non-invasive (in situ, or localized) have been detected. In men, 1,990 new case of invasive breast cancer were found. Less than 1% of breast cancer occurs in men.
What are the risk factors in breast cancer?
Only about 10% of breast cancers are due to heredity; 90% are due to genetic abnormalities that occur with aging and environmental factors or lifestyle. Some of the risk factors are regular alcoholic intake, smoking, trauma to the breast, and, very importantly, lack of awareness and familiarity with one’s own breasts, and carelessness and neglect about medical check-up. The heredity related breast cancers are due to gene mutation from one’s father or mother. The most common are mutations of the BRCA1 and BRCA2 genes. Those with these genes have up to 80% risk of having breast cancer even before they are 50 years of age, and also at risk of developing ovarian cancer. Men with BRCA1 gene have 1% risk by the age 70, and those with BRCA2, 6%.
How deadly is breast cancer?
The estimated US cancer deaths from all types of cancer in 2009 in women was 269,800, and in men, 292,540. Fifteen per cent (40,470) of these deaths in women was due to breast cancer, and 26 per cent (70,148) from lung cancer. For men, 9 per cent (24,282) die from prostate cancer, and 30 per cent (80,940) from lung cancer. The death rates from breast cancer have been decreasing since 1990 due to awareness, early detection from screening and advance treatment modalities for cancer. In 2008, 2.5 million women in the United States survived breast cancer.
A good rule: Live a healthy lifestyle and have a regular physical check-up. And when in doubt, seek medical consultation without delay.
***
Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email:[email protected]
