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Mammograms Get Vote of Confidence

Study finds women who get them regularly catch breast cancer in its earliest stage

TUESDAY, Oct. 8, 2002 (HealthDayNews) -- Chalk another one up for the view that annual mammograms save lives.

A study presented yesterday at the American Society for Therapeutic Radiology and Oncology's annual meeting in New Orleans found that women over the age of 40 who get routine mammographies are more likely to have breast cancer caught in its earliest and most treatable stage.

"I do agree with this study. I think that screening mammograms help us to detect breast cancers at an earlier stage," says Dr. Susan K. Boolbol, a breast surgeon at Beth Israel Medical Center's Cancer Center in New York City.

The issue has elicited a great deal of controversy ever since Danish researchers, publishing last year in The Lancet, questioned whether early detection actually reduced death rates.

"The controversy dealt with whether we are saving lives, and it's difficult to extrapolate that information," Boolbol says. "We do know that the death rate from breast cancer has decreased slightly over the past several years. Can we attribute that to mammograms alone? No, we cannot. It's a variety of things."

Similarly, there's been much debate about whether some breast cancers could be left untreated without resulting in the death of the patient. Again, the answer is unclear. "That very well may be true, but we do not know which ones. So, as physicians dealing with breast cancer every day, every breast cancer we detect we treat. And I think that in today's climate that's what every patient deserves," Boolbol adds. "Perhaps years down the road studies may show that we do not have to do that."

In this latest study, researchers at Fox Chase Cancer Center in Philadelphia looked at 1,591 women with recently diagnosed breast cancer who were over 40 years of age and who could provide information about previous mammograms.

Participants were divided into three groups, depending on their mammography history: the first was made up of women who had never had a mammogram before their diagnosis; the second included women who had had mammograms, on average, less than once a year; and the third was composed of women who had had mammograms an average of once a year or more.

Women who were screened at least once a year were most likely to have a diagnosis of stage 0 breast cancer (cancer that has not spread), compared to women in the other two groups. Because of the smaller tumor size, these women were also more likely to be given the option of breast-conservation therapy, as opposed to a mastectomy.

The earliest stage to detect breast cancer is ductal carcinoma in situ (DCIS). Before mammograms were used for screening purposes, about 5 percent of breast cancers were detected at this stage. Now, that number hovers around 25 percent, a huge increase. "The survival rate for women with DCIS is higher than 98 percent," Boolbol says. "So why not pick it up at this stage?"

Although the most dramatic difference could be seen between women with the most frequent screening and those with no screening at all, women who had had any screening were still more likely to have small tumors and to be candidates for breast-conserving treatments.

In this study, only 33 percent of women in the first group had their cancer detected by mammogram alone. That number rose to 49 percent in the second group and 59 percent in the third group.

Fifteen percent of patients in the first group had DCIS, compared with 21 percent of patients in the second group and 26 percent of patients in the third group.

Doctors offered 41 percent of the women in the first group the option of having breast-conserving surgery and radiation. That option was presented to 60 percent of the women in the other two groups.

Right now, the American Cancer Society advises women 40 and over to get annual mammograms. It's a recommendation the authors of this study stand by.

What To Do

For more on the mammogram controversy, visit the American Cancer Society.

For a range of information on breast cancer, visit the Susan G. Komen Foundation or Dia de la Mujer Latina, a community-based organization that provides breast health services to the Latino community.

SOURCES: Susan K. Boolbol, M.D., breast surgeon, Cancer Center , Beth Israel Medical Center, New York City; Oct. 7, 2002, presentation, American Society for Therapeutic Radiology and Oncology annual meeting, New Orleans
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