We are writing in response to the article in the insert “Fighting for a cure” in the Oct. 2 Tribune.
The title of the article is: “Are mammograms the best option for detection?”
In the article evidence is cited from several studies dating from 1992 to 2004 and a statement from the American College of Physicians from 2007. Studies were carried out in Canada and Denmark, where women are not offered screening mammography prior to age 50.
The author’s conclusion is that for women ages 40 through 49, mammograms may not be necessary and may do more harm than good.
More recently, in August of 2011 the American College of Obstetricians and Gynecologists (ACOG) issued a Committee Opinion that mammography is a particularly important screening tool in this population of women.
These same recommendations are endorsed by the American Cancer Society, the National Comprehensive Cancer Network, the National Cancer Institute, the American College of Surgeons, Nurse Practitioners in Women’s Health (NPWH), the American Academy of Nurse Practitioners, and the American College of Nurse-Midwives.
The reason ACOG recommends annual mammography in this group of women has to do with how fast tumors grow in younger women. Tumors detected at an early stage have a 98 percent five-year survival rate.
The time between when a tumor can be detected only by mammography and the time when it can be felt on examination is called “sojourn time.” It is in this early time when the tumor can be seen but cannot be felt on examination that it can be treated most effectively.
This time is shorter in younger women since cancer in younger women tends to grow more quickly and be more aggressive. Therefore, it is in this younger group of women that screening should be done annually.
The studies that were used to conclude that mammograms are not needed in younger women were done before many of the newer, effective treatments we have now were available.
In those days, younger women with breast cancer had a lower five-year survival than they do today.
We also find it ironic that on the same page an article entitled “Did you know?” states that the death rate for women in Canada with breast cancer is 9 percent higher than it is in the U.S.
Since some of the studies that were used to conclude that women should not have mammography between 40 and 49 were done in Canada, it seems likely that excluding these women from screening might be the one cause of their higher death rate.
In the article, exposure to radiation is cited as a reason for not screening, along with the anxiety caused by being called back for extra studies and the discomfort of biopsies that may not reveal cancer.
We are certain that in this very community, there are women in their 40s who have had treatment for breast cancer detected by screening mammography.
We’re sure that most of these women would agree that the small risk involved is worth the chance to treat their cancer with less invasive surgery at a stage when cure is more likely. MRI screening is discussed as an alternative however MRI has not been widely validated and therefore is not recommended at this time as a screening tool in women at average risk of breast cancer.
Some women who are at higher than average risk may have a combination of MRI and mammographic screening.
We strongly encourage women between the ages of 40 and 49 to have regular annual health visits, annual mammographic screening, and to do self-examination or practice “breast self-awareness.”
This means a woman should know what her breasts normally feel like and should report changes to her health provider.
Maxine Lingurar, M.D.,
Tatiana Kovtoun, M.D.,
Julie McClaren, ARNP,
Claudia Perez-Tamayo, M.D.,