Any news about breast cancer catches our eye. Like most of you, we know many women who are living with this terrible disease. But in the last few months, a spate of new studies appeared to be somewhat contradictory and left us (and presumably many of you) unsure about recommendations for screening. New research about who gets breast cancer and why also raised questions about how women should assess their personal risk. Finally, we were pleased by recent statistics showing an encouraging drop in death rates from breast cancer since 1990, but were puzzled by other data indicating that fewer women were getting mammograms. What does it all mean for you? Here's a rundown:
Screening. A few weeks ago, the American College of Physicians (ACP) issued new and somewhat surprising mammography guidelines. The group stated that women in their 40s should talk to their doctors about their risk of breast cancer and use that information to decide whether they need to get annual mammograms before age 50. Almost immediately, the American Cancer Society responded by reiterating their position that all women should begin getting annual mammograms in their 40s.
Whose advice should you follow? Dr. Lynne Kirk, president of the ACP, says her group's recommendation results from its survey of the evidence about the effectiveness of mammograms for younger women. The survey "generally found the benefits were less than they were for older women and the risks were greater." Younger, premenopausal women have denser and lumpier breasts than older women and that makes their mammograms much harder to analyze. They are also more likely to get a "false positive" result—a call from the doctor to get a second test for a lump that turns out to be benign. That call can be understandably scary and can cause many anxious moments before the final results are in. They also point out that mammography exposes patients to a small amount of radiation, which can increase cancer risk. That's why the ACP urges doctors to discuss the test with their younger patients and let the women choose whether they want to move ahead. "We think it should be an individual decision," Kirk says. But Dr. Robert Smith, director of cancer screening for the ACS, says women in their 40s should understand that tumors in younger women can be much more aggressive—a reason for annual screening. And, Smith says, in any given year, about 16 percent of breast-cancer deaths can be attributed to cancers first diagnosed when women were in their 40s.
The single biggest risk factor for breast cancer is advancing age, but it's far from the only issue to consider. Dr. Daniel Sullivan, director of the National Cancer Institute's Cancer Imaging Program, says that a woman's menopausal status may play a role in the decision to start getting annual mammograms. Because breasts are less dense after menopause, mammograms are more effective and it makes sense for a woman to get checked. That means that a fortysomething who is already postmenopausal could be a better candidate for an annual mammogram than a 50-year-who is still getting a period every month.
Diagnostic tools. Most of us are used to getting mammograms, but you should also know about some recent evaluations of other screening techniques. A study in the April 5 issue of the New England Journal of Medicine found that computer-aided detection (CAD) led to too many false positives and unnecessary biopsies. The CAD programs were supposed to help radiologists find tumors; instead, the study found, experienced radiologists did better on their own. If you get a call back after a mammogram, make sure the radiologist has really examined your test and isn't simply relying on CAD.
Magnetic resonance imaging (MRI) got a better review in a study published in the March 29 issue of the New England Journal of Medicine. Once cancer has been detected in one breast, researchers found that screening the other breast with MRI was effective in picking up 90 percent of tumors missed by mammograms and clinical breast exams. The American Cancer Society also recently issued new guidelines saying that women with a high risk of breast cancer should get MRI scans along with their annual mammograms. Because MRIs are more sensitive than mammograms, the test may also lead to false positives, so doctors say the procedure should be limited to women who are clearly vulnerable because of their personal or family history. Ask your doctor if you're a candidate for this, advises Sullivan.
Risk. A study in the May 15 issue of the journal Cancer found that among patients with equal access to health care, Hispanic women were at significantly higher risk of being diagnosed with more advanced and more aggressive tumors than non-Hispanic white women. The study is in line with earlier research that shows important differences in breast-cancer rates among women of different ethnicities and races. For example, death rates for breast cancer are much higher among African-American women than white women even though white women are more likely to get the disease. Understanding these differences is a growing area of research, but until scientists know more, you should use the current data when you and your doctor assess your risk.
Rates. It's that old cliché: good news and bad news. The good news is that breast-cancer deaths among American women dropped 24 percent from 1990 to 2003. Doctors credit improved screening and use of the drug tamoxifen to block the growth of estrogen-sensitive tumors. But data released in January from the U.S. Centers for Disease Control and Prevention (CDC) shows that fewer women are now getting mammograms. The percentage of women over 40 who reported having had a mammogram in the past two years was 76.4 percent in 2000, but had dropped to 74.6 percent by 2005—a drop the CDC describes as statistically significant. It translates into 1.5 million fewer women getting mammograms. Were you one of them?