Mammograms, Breasts and Exams…oh My!

Thinking PINK? October is Breast Cancer Awareness month, and pink ribbons are popping up on everything from restaurants and t-shirts to football socks. I love that as a community, we can rally around a cause to raise not only awareness, but also much needed funds for research and support of those affected.

The American Cancer Society statistics reveal that here in the United States, over 230,000 women will be diagnosed with breast cancer during 2015, and sadly, over 40,000 women will likely lose their lives to this disease. The good news is detection methods continue to improve, allowing these cancers to be diagnosed and treated earlier, leading to better outcomes and treatments that are better tolerated.

With all the changes in women’s preventative health, many are confused about current recommendations for breast cancer, including health care providers. Different organizations have conflicting guidelines, which fuels the continued media controversy surrounding mammograms.

The United States Preventative Services Task Force (USPSTF) recommends routing SCREENING mammograms every other year for women ages 50-74. I emphasize “screening” because this guideline is for women with no symptoms, no concerning breast lumps and no extra risk factors. If a woman goes to the doctor with a concerning lump in her breast, imaging is most likely indicated- this is not “screening” in this situation, it is “diagnostic.” The USPSTF also no longer promotes self-breast exams, because some large studies have not shown these exams to be globally beneficial. Statistically, self breast exams do not cut down on the number of deaths from cancer, and do lead to extra imaging studies (mammograms) and breast biopsies.

The American Cancer Society (ACS) still recommends annual mammograms for women forty and over, as long as they are in good health (not stopping at age 74 purely for too many birthdays, but rather only stopping if the woman has a shortened life expectancy from other serious medical issues.) ACS also still supports self breast exams for women starting in their twenties.

Given this information, do I still teach self breast exams? Right now, I am only seeing patients in an urgent care setting, so I do not have the opportunity to perform “well woman” exams. However, if I am seeing a patient with a breast-related issue that involves me doing a clinical breast exam, then YES, I do explain to patients what to expect when they perform a self-breast exam. I am not on the band wagon insisting patient MUST do these exams religiously on the first of every month (or after their period) as I used to suggest.

One of the greatest challenges in modern medicine is trying to practice evidence-based medicine that is recommended for the global good, versus a clinician’s personal experience and success with individual patients. In this case, during my twenty years of private practice, I had numerous patients who found their own breast cancers during routine self-exams, and were quickly diagnosed, treated and cured- often with simple surgical lumpectomies without additional chemo therapies. Would they have been so fortunate if they had not noticed a lump and simply waited for routine screening? We don’t know, but most of these women within my practice were younger than 50, so I believe many may have developed more advanced cancers. And so I am conflicted, and continue to follow evidence-based research and extended discussions about pros and cons of breast exams.

BOTTOM LINE: Talk with your doctor about your personal risk for developing breast cancer, and together discuss your prevention strategy- including frequency and timing of breast exams, imaging with mammography or other modalities, and possible genetic testing if breast cancers run in your family.

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