Weekend Doctor

By DR. RICHARD POLDER
Yes, mammograms do save lives, although fewer than most people might believe.
During the past few years, there has been considerable debate over some of the fine points of screening for breast cancer.
However, all of the major organizations involved with breast care continue to recommend routine screening mammography. This includes the American Cancer Society, the National Cancer Institute, the National Comprehensive Cancer Network and the U.S. Preventive Services Task Force.
There is general agreement that the death rate from breast cancer will be reduced by about 20-30 percent with routine screening. This translates into the need for about 200 women to be screened for 20 years to prevent one death from breast cancer.
The actual incidence of breast cancer is much higher. About 13 women, or 6.5 percent, in this group will have developed breast cancer. Most will survive, but some will die from their disease despite the addition of mammography.
For women ages 50-70, there is little debate, although still some, about the efficacy of detecting breast cancers earlier with screening mammograms, and therefore improving survival. The benefit for women in their 40s appears to be less, about 15 percent reduction in mortality, but still present.
The value of mammography has to be weighed against its risks. Many women are concerned about the risk of the radiation.
However, with today’s techniques this is a very small, or possibly even a non-existent risk, with likely less than one cancer formed for every 10,000 women screened for 10 years.
With screening, abnormalities will be found in 11 percent of mammograms. Most will turn out to be completely benign. However, about 3 percent of the abnormal mammograms will result in a diagnosis of cancer.
As these abnormalities are being worked-up, some women will need additional studies or biopsies for lesions that ultimately prove to be benign. There are also the issues of anxiety, pain and expense.
It is also important for women to understand the limitations of mammography.
Mammograms will detect most breast cancers, including many that are too small to detect by physical examination, but will still miss up to 20 percent of cancers in younger women in their 40s, due to their denser breasts, and 10 percent of cancers in older women.
For this reason, although a mammogram is an important screening tool, obtaining a normal result on a mammogram should never stop a woman from having a breast abnormality checked by her health care professional.
Despite the significant risk of developing breast cancer, roughly one in eight women born today who live to be 90, the incidence is decreasing over time.
And, the cure rate has increased due to earlier detection and more effective treatments. Most women who develop breast cancer will be cured, and mammography remains important in this fight.
Women between ages 50 and 70 should have a screening mammogram every year. Healthy women over age 70 should continue to be screened.
For women between ages 40 and 50, most organizations also recommend yearly screening, however, due to somewhat less effectiveness in that age group, if a woman has questions about screening she should discuss them with her health care professional.
Routine clinical breast exams by a health professional and breast self-examination are encouraged, but have a less proven benefit in early detection.
High quality digital mammograms are available in Findlay, and are read by a dedicated mammographer. Free mammograms are available if need is demonstrated.
Polder is with Findlay Surgical Associates. Questions for Blanchard Valley Health System experts may be sent to Weekend Doctor, The Courier, P.O. Box 609, Findlay, OH 45839.

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