Breast Pressure: Is Mammography the Answer?

I’m 36. Pretty soon, my doctor is going to start nagging me about getting a mammogram. The thought makes me uncomfortable. It’s not the thought of having my boobs under the pressure of a machine and the discomfort that may bring. I just don’t know what to think about mammograms.  I am told that they save lives through early detection and are responsible for the drastic decline in breast cancer deaths. Yet, an article in BJM concluded a study by stating, “We believe it is time to question whether screening has delivered the promised effect on breast cancer mortality”.

That study compared two different regions in Denmark. In one region, women were rarely screened for breast cancer using mammograms. In the other, women had a high incidence of mammogram use. That study was unable to find evidence that screening reduced mortality. Both areas had reductions in breast cancer at similar rates since mammography was introduced. They stated, “The reductions in breast cancer mortality we observed in screening regions were similar or less than those in non-screened areas and in age groups too young to benefit from screening, and are more likely explained by changes in risk factors and improved treatment than by screening mammography.”

Even more surprising, that article stated that the study found, “Among women who could benefit from screening (ages 55-74 years), there was a similar or larger decline in breast cancer mortality among women in areas that did not use screening than in those that did.” [Emphasis mine.]

*sigh*

The Cancer Prevention Coalition suggests that the best method of detection is still regular old breast exams and says that mammography is unreliable and risky.  As far as risks go, they take the following into consideration when they made their suggestion:

• Radiation Risks- The cumulative radiation from routine mammography, they say, poses significant risks of initiating and promoting breast cancer. “Thus, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads for each breast. As emphasized some three decades ago, the premenopausal breast is highly sensitive to radiation, each rad of exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of premenopausal screening, usually from ages 40 to 50.” Say what?!?!
• Cancer Risks from Breast Compression- The CPC goes so far as to suggest that maybe I should be uncomfortable with the discomfort of the squeeze after all. It states,  “Mammography entails tight and often painful compression of the breast, particularly in premenopausal women. This may lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small, as yet undetected breast cancers.” I don’t actually know WHAT to say.

Then, we have CBS News reporting last September that mammograms may increase cancer risks too. It certainly didn’t go so far as to tell us to stop getting mammograms but did say that in some countries in the UK, doctors suggest MRIs over mammograms and also said, “Researchers found women with a history of chest radiation in their 20s had a 43 percent increased relative risk of breast cancer compared to women who had no chest radiation at that age. Any exposure before age 20 seemed to raise the risk by 62 percent.” Now, I don’t know anyone personally who get mammograms that early, but the study they’re talking about accounted for chest x-rays as well as mammograms. They were also talking about women with a specific gene mutation. And while the risk increase wasn’t significant in older women, the idea that in younger women in that risk group it raised the risk by 62% indicates to me that there genuinely may be something to this theory that was mentioned by the Cancer Prevention Coalition wherein mammography may actually increase cancer risks.

Top that off with even an article in The New England Journal of Medicine questioning the use of mammograms. No, seriously… That article concluded, “Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer. Although it is not certain which women have been affected, the imbalance suggests that there is substantial overdiagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer.”

Add to this confusion the idea that through mammography, certain breast cancers that are considered “slow growing that would never have posed a threat to women in the first place” are often detected in young women and you have an incidence of what experts are calling, “overdiagnosis.” I read that in 2000 mammograms, one aggressive cancer would be found, but 10 nonthreatening cancers would be needlessly treated in an aggressive fashion.  That one life would be worth it to me, but not if in the process, cancer risks are being increased among the rest because of the compression and radiation.  You know? Dartmouth Institute for Health Policy and Clinical Practice’s H. Gilbert Welch shockingly explained, “The question is no longer whether overdiagnosis occurs, but how should we react to it,” and he continued, “It’s not an imperative to be screened; in fact, it’s a close call.”

And so now, I don’t know what to do. What will you do?