Thursday, August 4, 2011

Maryl writes: I won again! A clean mammogram.

I’m “Normal/Negative – No evidence of cancer” as of last week, ten years and running, which is as long as I’ve been keeping the form letters I receive upon completion of my yearly mammography. I don’t know why I keep them. Maybe it’s like a little trophy for a race I’ve won until next year’s competition and Normal/Negative is the gold medal, except it’s one I’m more than willing to share with the entire female population. After all, one in eight women in the United States will develop breast cancer in their lifetime and I’d like to see fewer losers in this event.

Panini Press
Mammography remains the “gold standard” breast screening method but there’s been much controversy surrounding it lately: the age a woman should have her first mammogram, how frequent, and then what method – regular film or digital mammogram, ultrasound and/or MRI? (See the Harvard Women’s Health Watch, May 2010, “Advances in breast imaging”) for a complete rundown of all the breast imaging methods.) If you have denser tissue as I do, you will probably begin with digital mammography. It still involves smashing each breast together between two plates - like an Italian pressed sandwich - followed by a sonogram and anxious waiting in between takes. 

Much of the debate started in November 2009 when the United States Preventive Services Task Force (USPSTF) updated their mammography guidelines. They upped the starting age from 40 to 50 for women of average risk. Average risk means you have no genetic mutation, no strong family history of cancer and no history of radiation to the chest area. The USPSTF also reduced the frequency from one to two years, recommended against teaching breast self-examination but did not assess the other screening methods. These USPSTF guidelines raised a lot of concern among women that their health was being treated more like a political decision and not a medical one. The main issue is the number of false positives that add expense and worry. According to their model, the number of deaths prevented is too small and the possible harm from false positives too great.

Last week the Wall Street Journal (“New Advice on Mammogram Timing”) reported that the new recommendations from the American College of Obstetricians and Gynecologists (ACOG) may only have added to the commotion. Their update stated that women at average risk should have a mammogram every year starting at age 40. Although women in their 40s (one out of 1904) have a lower overall incidence of breast cancer compared with older women (one out of 1339 in their 50s and one out of 377 in their 60s ), the window to detect tumors before they become symptomatic is shorter by two years on average. The American Cancer Society (ACS) is in basic agreement with this. A recent university (UC, San Francisco) report on this matter added some new criteria to be considered: starting age and frequency should depend on breast-tissue density, history of biopsy and family history and a woman’s own preference. In the end as the Harvard Women’s Health Watch, February 2010, (“A doctor talks about: Screening mammography”) reminds us “that where breast cancer screening is concerned, one size (or frequency) doesn’t fit all.”

So I’m good for another year to pursue my dreams without that particular kink in my life plans. Big sigh assuming my mild asthma doesn’t worsen – this summer heat has had me hacking, my melanoma doesn’t reoccur - 30+ years cancer-free, my semiannual visits to my gynecologist doesn’t reveal any ovarian abnormalities – my mother was stricken with ovarian cancer in her 80’s. (I‘ve done the BRCA1 and BRCA2 genetic testing and I have no mutations. I kept that letter too.) So I walked out into the sunshine last Tuesday knowing I can make decisions more freely on what I’ll do this year, this month, this week, today, for lunch…….maybe curried chicken salad or a Kobe burger..…definitely not a Panini.

Recap of links:
1) Breast cancer stats
2) Harvard Women’s Health Watch, “Advances in breast imaging
3) USPSTF guidelines
4) WSJ “New Advice on Mammogram Timing
5) ACOG recommendations
6) American Cancer Society guidelines
7) Harvard Women’s Health Watch, “Screening Mammography

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