mind & body
can pick up breast cancer one to two years earlier, giving women a much better prognosis.” Typically, breast cancer doesn’t become palpable until it’s about one inch in size, says Griffin. “Mammograms can detect new changes in the breast as small as a pinhead.” When breast cancer is caught
when it’s that small—long before it’s palpable—and while the tumor is still confined to the breast, the five-year survival rate is 98 percent. And 90 percent of women who are treated at this early stage remain cancer-free for a decade or longer, studies show. The interval between
various ages found that women in their 40s or 50s who were screened regularly were about 15 percent less likely to die from breast cancer, compared with women the same age who didn’t get mammograms. Women in their 60s benefitted even more, with a 32 percent drop in fatal breast cancer if they had regular mammograms. However, because fewer
young women develop breast cancer, they don’t benefit as much from mammograms as their older sisters do. To prevent one death from the disease, 1,904 women in their 40s need to be screened,
The benefits of routine mammograms diminish relative to the harms of overtreatment for women beyond age 75, according to ACOG. Older women should consult with their physician and decide whether to continue mammography screening.
there’s a finding that needs to be evaluated further to see if there is a problem,” says Griffin. “While some women see this drawback as a reason not to be screened, it’s important for physicians to educate patients that callbacks are common, and most of the time there’s nothing to worry about. Out of 100 women who get callbacks, on average, three will turn out to have breast cancer.” Some women may be concerned
about radiation exposure from mammograms, but improvements in screening equipment and techniques today result in very low exposure to radiation, even with repeated mammography.
when a breast cancer tumor can be detected by mammography and when it grows big enough to cause symptoms is called sojourn time. While sojourn time can vary, the greatest predictor is age, with women in their 40s having the shortest average sojourn time (2 to 2.4 years) and women in their 70s having the longest (4 to 4.1 years).
Weighing the Risks and Benefits What are the pros and cons of screening? There’s compelling evidence that mammograms save lives. A recent analysis pooling results from eight previous mammography studies involving more than 600,000 women of
24 pause FALL / WINTER 2011
compared with 1,339 women in their 50s and 377 in their 60s. Other advantages of catching cancer early include less invasive surgery (such as a lumpectomy versus a mastectomy and lymph node removal, if the cancer has spread) and less toxic treatments. Women with early stage breast cancer may not need chemotherapy, sparing them side effects such as nausea, diarrhea, and hair loss. The downside of screening is the
possibility of anxiety-inducing false alarms (results that look like cancer but aren’t). “If women are screened every year with mammography, close to half of them will experience a callback for further imaging at least once during their lifetime because
Rating Your Breast Cancer Risk Now that Calt has recovered from surgery, she’s undergoing six weeks of radiation treatment. “My grandmother died from breast cancer, and if I’d thought this through, I wouldn’t have put off having mammograms.” A genetic test showed that she is a carrier of the BRCA1 gene, which greatly increases the risk for both breast cancer and ovarian cancer. To reduce the threat of a recurrence, Caroline’s doctor has prescribed tamoxifen, an oral breast cancer medication, that she’ll take for five years after she finishes radiation therapy. By sharing her story, she adds, “I hope I can help another woman face her fears and understand how crucial it is to her health to have mammograms done on a timely basis.” While my friend Paula continues
to question the value of breast cancer screening, there is one scenario that would convince her that a mammogram was essential.
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