Tuesday, October 30, 2007

No Pink Ribbons, But This

We come to the end of October, and to the end of the 23rd annual Breast Cancer Awareness month, which began in 1985 to promote early detection of the disease. Generally, the methods recommended are self-examination, yearly examination by a doctor, and at some point, a yearly mammogram screening.

As a cancer survivor, I am aware of cancer. If I put a stick of artificially sweetened gum in my mouth “cancer” flashes through my mind. When I get too busy and don’t exercise for a week, I can't help considering how that relates to my cancer statistics, so it’s no surprise that I wouldn’t make a decision to have a mammogram before investigating what additional cancer risk that action might add, and seeing if there are any other viable choices. So in the spirit of the month, I thought I’d share some of the links I found, and my own conclusion, in hopes that we can all be aware of our options.

While articles and websites in support of the mammogram tend to use words like “slight” and “very low” when describing the increase in risk due to radiation exposure from mammograms, not everyone treats the accumulated exposure from annual screenings, usually consisting of two to four films (2 views of each breast) per screening, so lightly. Various articles I’ve read that deal with the numbers in a fairly clear way are here and here. A site that is plainly opposed to what it sees as an exploitive amount of mammography use, and which brings up interesting questions regarding how helpful the practice really in terms of boosting survival rates, and possible conflicts of interest between the mammography industry and various cancer organizations, is here.

One question I had after reading articles like this and this, was “Why, if ultrasound is used after mammograms to determine the nature of a mass (whether it is fluid or solid), can’t it be used to screen for a mass in the first place?”

I made my own decision regarding breast cancer screening when I found an article in the American Journal of Surgery in 2004 entitled, “Ultrasound is now better than mammography for the detection of invasive breast cancer.” I had to access the article through my university’s Science Direct account, so I’ll quote the abstract here:

Objective: This study investigated the use of ultrasound (US) as a first-line diagnostic tool.

Methods: All women attending our breast center underwent bilateral whole-breast US in addition to all other investigations, and results were documented prospectively and preoperatively.

Results: Of 796 patients with breast cancer, US was positive in 710 (89%) and mammography in 706 (89%) (P = not significant). Either US or mammogram was positive in 770 (97%). Of 537 (67%) symptomatic patients, US was positive in 497 (93%) and mammography in 465 (87%). Either US or mammography was positive in 515 (96%). Of 259 (33%) screening patients, 220 (85%) had invasive cancer. US was positive in 195 (89%) and mammography in 203 (92%) (P = not significant). Either US or mammography was positive in 217 (99%). Of 39 screening patients with ductal carcinoma in situ (5% of all patients), US was positive in 18 (46%) and mammography in 38 (97%).

Conclusions: US is significantly better than mammography for detecting invasive breast cancer (92% patients). The combination of US and mammography is significantly better than either modality used alone, together resulting in 9% more breast cancers detected.
(The American Journal of Surgery, Volume 188, Issue 4, Pages 381-385
S. Benson, J. Blue, K. Judd, J. Harman)

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