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I have practiced oncology and hematology in Los Alamos for two years alongside Dr. Peter Lindberg.
Dr. Lindberg works on Tuesdays and cares for patients with prostate cancer. I take care of people with all other cancers and blood disorders all the other days of the week.
My practice is diverse, ranging from providing care for people with anemia to those with multiple myeloma, breast cancer, colon cancer, lung cancer, malignant brain tumors and many other diseases. They are from all walks of life.
I frequently work with medical oncologists and surgeons from around New Mexico and out-of-state.
In our practice, we answer many and varied questions, and I would like to address one we are hearing very often, based on reports in the media: Should women between the ages of 40 and 49 receive annual mammograms?
Recently, the U.S. Preventive Services Task Force (USPSTF) revised its recommendations for mammograms, and no longer recommends annual mammograms for women between the ages of 40 and 49 or for women over the age of 75.
The USPSTF now says that women between the ages of 50 and 74 should receive mammograms every other year.
The USPSTF also no longer recommends self-breast examination and physician breast examination.
As a medical oncologist with a special interest in breast cancer, I do not agree with these recommendations, and in talking to radiation oncology, medical oncology, and breast radiologist colleagues over the last two months, neither do many of them.
Since USPSTF released their recommendations, the British have evaluated their own data and determined that over a 20-year period, screening 1,000 women saves more than five lives. Over-diagnosis due to mammogram screening (i.e. needing additional imaging or a biopsy) was seen in only 2.3 out of 1,000 women, proving that screening is beneficial.
In New Mexico, approximately 20 to 25 percent of breast cancers are diagnosed before the age of 50 as estimated by XRAY Associates of New Mexico.
In the last 20 years we have seen an approximately 30 percent drop in breast cancer deaths using the previous screening guidelines, recommending annual mammograms from age 40 and older.
In addition, multiple, very large clinical trials of mammogram use show a 30 percent to 45 percent decrease in breast cancer deaths.
All of this data tells us that mammograms save lives and detect breast cancer at an earlier stage when it potentially can be cured. Anecdotally, I’ve lost count of how many patients I have seen who have found their cancers through their own self-breast exams.
The Task Force report states that mammograms decrease death from breast cancer by only 15 percent in women ages 40-49 and “cause harm” because of further work-up and biopsies.
Even if task force members choose to claim that mammograms prevent only 15 percent instead of 30 percent-45 percent, I personally would want all my patients to have the opportunity to have their cancers diagnosed early when the cancer is potentially curable.
Most women don’t like mammograms, but they are very happy when their mammogram shows that once again they don’t have cancer.
Likewise, women are extremely happy when a biopsy comes back negative for cancer. Sure, it is “no fun” to have a mammogram or a biopsy, and mammograms and biopsies can result in discomfort and pain and bruising at times.
But is this really harm? While it may cost more to do annual mammograms, wouldn’t we want to spend health care dollars on younger women as well as older females? If we can detect cancer and prevent death in any women between the ages of 40 to 85, shouldn’t we do that, because cancer is also a “harm” to us, and death from cancer is not a pleasant experience under any circumstances.
Can mammograms potentially cause cancer? Yes, rarely it does occur. Like other technologies, mammograms are not perfect, and it may be that they are replaced with a newer technology such as mammothermagrams in the future. But mammograms, ultrasounds, and biopsies are the best we have right now; we are saving lives with mammograms.
In my opinion, women should have a screening mammogram every year from the age of 40 until your physician tells you that you no longer need this annual exam.
For some of us, our health may not be very good at the age of 70, and we should stop annual mammograms then.
Others of us may have very few or even no medical problems at age 85, with the result that we live another 15 years or more. If that’s the case, we should continue to get annual mammograms until the age of 85.
After considering all the data, if you get your mammogram every year starting at the age of 40, you’ll know that you are decreasing your risk of dying from breast cancer by doing so (even if you are only decreasing that risk by 15 percent, according to the USPSTF.)
And go ahead - do your own breast exam and ask your physician to do one once a year. If you or your physician find your cancer even earlier than your annual mammogram, you may have saved your own life by doing a simple exam.
Let’s continue to reduce the number of deaths caused by breast cancer.
Jan M. Merin, MD, MPH, is a Board-Certified Medical Oncologist in practice at Northern New Mexico Cancer Care, located on the campus of Los Alamos Medical Center.