In the era of fake news, it is difficult to know who to trust. New screening mammography guidelines published this week from the American College of Physicians (ACP) have caused a stir. Since the 1980’s, mammograms were (and still are) the best way to detect breast cancer early.
When breast cancer is caught early, before it spreads, the chances of survivorship are much higher. Today there are 3.5 million women that are breast cancer survivors. That wouldn’t be the case if women in the 80s didn’t march on Washington to get insurance to cover screening mammography. And now, nearly forty years later, some doctors giving away that precious right for women to be screened in the name of public health or saving some dollars for the insurance companies.
The ACP’s new guidelines are only for women with average risk and no symptoms or problems. They endorse screening mammograms for such women starting at 50 and performed every two years until age 74. This is similar to the US Preventative Task Force’s recommendation that caused such confusion in 2009.
Now three large organizations, the American Cancer Society, The American College of Radiology, and the Society of Breast Imaging, still agree that the most lives are saved by annual screening starting at age 40. The ACR and SBI continue to recommend that women start getting annual mammograms at age 40 and continue as long as they are in good health.
Why the differences of opinion?
Different data. Different goals. Different experiences.
There are three main points that the ACP has overlooked in their public health review for early detection. The Society of Breast Imaging discusses them well.
The ACP claims that guidelines recommending that screening start at age 40 ignore the “low incidence of breast cancer for women younger than 60 years.” In fact, the majority of in situ cancer and nearly half of all breast cancers occur in women under 60. Also, the majority of life years lost to breast cancer occur in women diagnosed younger than age 60. Breast cancer is the most common cancer in women and the second leading cause of cancer death in women. It should be taken seriously at all ages.
The ACP also claims, “Every other year mammography screening results in no significant difference in breast cancer mortality.” This is incorrect. There have been no randomized controlled trials to test this ACP claim. In fact, the NCI/CISNET models that were used by the USPSTF and the ACS actually show a major decline in deaths among women screened annually vs. every other year.
The ACP guidelines also fail to address groups who have a greater risk of developing breast cancer at a young age and dying from the disease. For instance, black women have a 30 percent higher breast cancer death rate than white women (DeSantis et al). Also, breast cancer incidence peaks in the late forties in non-white women and in the sixties in white women (Stapleton et al). The ACP approach may exacerbate racial disparities in breast cancer outcomes.
- ACP Guidance Underestimates Mammography Benefits and Greatly Overstates Risk of Harm
More doctors support annual screening in women 40 and older than screening later in life or less frequently. National Cancer Institute (SEER) data show that, since mammography became widespread in the 1980s, the U.S. breast cancer death rate, unchanged for the previous 50 years, has dropped 43 percent. A recent study in Cancer showed that women screened regularly for breast cancer have a 47 percent lower risk of dying from the disease within 20 years of diagnosis than those not regularly screened. Large studies (Otto et al. and Coldman et al) show that regular mammography use cuts the risk of dying from breast cancer nearly in half.
Screening risks are often overstated due to faulty assumptions, methodology and hyperbole in articles on which such claims are based. Overdiagnosis means finding cancers that will not grow to kill you before something else does. Overdiagnosis will not be reduced by delayed or less frequent screening. These “overdiagnosed” cancers would still be found by the next screening exam and result in the same work-up, biopsy and treatment. If an aggressive cancer goes undiagnosed because of a longer interval between screenings or starting screening at a later age, treatment will be delayed with higher potential morbidity and a lower chance of saving a woman’s life. Screening-detected breast cancers do not disappear or regress if left untreated.
A British Medical Journal study, using direct patient data, shows that breast cancer overdiagnosis is about 2 percent. An article in The Oncologist shows that studies with high overdiagnosis claims are not well-founded. American Cancer Society findings re-confirmed that overdiagnosis claims based on modeling studies are inflated.
A Journal of The American Medical Association (JAMA) study has shown that normal and understandable anxiety from inconclusive mammogram results or false positives is brief and has no lasting health effects. Research shows that nearly all women who have a false-positive exam still endorse regular screening and want to know their status.
Short- term anxiety from test results, a small percentage of women called back to double-check something and overstated overdiagnosis claims do not outweigh the thousands of lives saved each year through annual mammography screening starting at age 40.
So, while the confusion grows over when to start getting your mammogram, I can tell you from 35 years of personal experience that early detection works. The question has and remains a very personal one. Every woman is different, but every woman deserves the right to choose what is right for herself. For all the reasons above and seeing it personally, we recommend getting a baseline mammogram at 40 and continuing annual screening afterwards because the two biggest risk factors in breast cancer are two we can’t control: being a woman and growing older.
Breast cancer is common in the United States and other developed countries, with one in eight women being diagnosed during their lifetime.
Most women who are diagnosed with breast cancer have no substantial risk factors. I cannot tell you how many patients I have had who tell me, “This can’t be breast cancer. I exercise every day. I eat really healthy and I have no family history of cancer. This can’t happen to me. I do everything right.” And yet they ARE diagnosed anyway.
Our BEST defense is a good offense. Since breast cancer is so very common, our best strategy is to minimize the impact, if and when we are diagnosed with this common disease. Anyone who treats breast cancer can tell you that the earlier the diagnosis, the more likely and easier it is to cure.
Keep in mind that 80% of breast cancers that are diagnosed are in women who have NO family history of breast cancer.
All women in their 40’s should undergo mammograms EVERY year. One out of every 64 forty year old woman, i.e., the average risk woman (a woman with no family history of breast cancer) is diagnosed with breast cancer. Women who are diagnosed with breast cancer in their 40’s make up almost a third of breast cancer deaths because cancers tend to be more aggressive in young women.
Having a mammogram every year results in the fewest breast cancer deaths at all ages. Some women may consider choosing to have a mammogram every other year after age 55. Yet the average doubling time of a breast cancer is one year. So the best interval for screening is one year. If you have dense breast tissue or any family history of breast cancer, you should still have a mammogram EVERY year because your risk is higher than average of having breast cancer.
If you have dense breast tissue, which appears white on the mammogram, you are more likely than the average woman to be diagnosed with breast cancer. In addition, that white tissue can make it harder to see cancers on mammography. Breast ultrasound screening is the best imaging exam to complement the mammogram to find cancers with a dense mammographic pattern. This has been proven in a number of studies.
Optimize your ability to beat this disease by getting a mammogram every year beginning at age 40. Although some women will choose to have less frequent mammograms as they get older, this is not a good idea. Our chances of getting breast cancer increase with age: 1 out 12 seventy-year old women get breast cancer and 1 out of 8 women in their eighties are diagnosed with breast cancer. If older women do not have any overwhelming health problems and are mobile, they should continue with annual mammography. If there is a family history of breast cancer, prior biopsies with abnormal cells or dense tissue, women should continue to get a mammogram EVERY year and ultrasound to help find breast cancers earlier. Help us help you!
LIVESTRONG at the YMCA
PROGRAM OVERVIEW – DOWNLOAD PDF FLYER
LIVESTRONG at the YMCA is an evidence-based program that helps adult cancer survivors reclaim their health and well-being following a cancer diagnosis. Participating YMCAs create a welcoming community in which survivors can improve their strength and physical fitness, diminish the severity of therapy side effects, develop supportive relationships, and improve their quality of life. Since 2007, the LIVESTRONG Foundation has been the YMCA’s partner in developing and delivering LIVESTRONG at the YMCA.
DESCRIPTION AND GOALS
⦁ Small group, supportive environment
⦁ 12-week program with two 90-minute sessions per week⦁ Includes cardiovascular conditioning, strength training, balance, and flexibility exercises⦁ Held in YMCA “Wellness Centers”⦁ Evaluation includes Functional and Quality of Life assessments before and after participation⦁ Facilitated by YMCA-certified Instructors
⦁ Includes cardiovascular conditioning, strength training, balance, and flexibility exercises⦁ Held in YMCA “Wellness Centers”⦁ Evaluation includes Functional and Quality of Life assessments before and after participation⦁ Facilitated by YMCA-certified Instructors
⦁ Held in YMCA “Wellness Centers”⦁ Evaluation includes Functional and Quality of Life assessments before and after participation⦁ Facilitated by YMCA-certified Instructors
⦁ Facilitated by YMCA-certified Instructors
IMPACTLIVESTRONG at the YMCA has proven to
⦁ Help survivors MEETOREXCEED the recommended amount of physical activity
⦁ Help survivors SIGNIFICANTLYINCREASE their cardiovascular endurance
⦁ IMPROVE cancer survivors’ overall quality of life and DECREASE their cancer-related fatigue
Any adult 18 years old or older who is living with or beyond cancer treatment.
2017 CLASSES IN KNOXVILLE ENROLLING NOW:
CANSLER FAMILY (Downtown) Mondays and Thursdays 6:30pm 7/31 to 10/26
DAVIS FAMILY (Farragut) Mondays and Thursdays 1:00pm 7/31 to 10/26
DOWNTOWN (Downtown) Mondays and Thursdays 9:00am 7/31 to 10/26
NORTH SIDE (Halls) Mondays and Wednesdays 11:00am 9/18 to 12/13
WEST SIDE (West Knox) Mondays and Thursdays 2:00pm 8/14 to 11/2
FOR MORE INFORMATION, CONTACT:
Vickey Beard, VP of Healthy Living
Medical Clearance Form
Dear Doctor _______________________________,
Your patient ________________________ has requested to participate in LIVESTRONG at the YMCA: A Cancer Survivor Exercise Program at the ________________ YMCA. At the start of this program, your client will participate in a fitness assessment, including the 6-minute walk test, one repetition max test for upper and lower body, and balance and flexibility test. Following the fitness assessment, your patient will partake in cardiorespiratory fitness, muscular strength and endurance, and flexibility and balance activities. A specific, individualized exercise program will be created for the participant based on the needs, interests and any recommendations you might have. The LIVESTRONG program is designed to start easy and become progressively more difficult over a 12 week period. All fitness assessments and exercise activities will be administered by qualified personnel trained in conducting exercise test and exercise programs.
Based on the LIVESTRONG at the YMCA intake form, your patient has indicated a diagnosed medical condition, coronary risk factor, and/or health condition that require a physician’s clearance prior to participation in the LIVESTRONG at the YMCA program.
By completing the form below, you are not assuming any responsibility for our administration of the fitness assessment or exercise program. If you know of any medical or other reasons why participation in the LIVESTRONG at the YMCA program would be unwise for your patient, please indicate so on this form.
If you have any questions regarding the LIVESTRONG at the YMCA program, please call the program coordinator.
Program Coordinator: Vickey Beard or Christine Canges Phone ( 865 )637-9622
Return Fax (865)766-8448
My patient, listed above, is:
_______Not cleared to exercise at this time
_______Cleared to exercise with no restrictions
_______Cleared to exercise with the following restrictions and/or recommendations
Physicians Name: __________________________________
Physicians Signature: _______________________________ Date: ____________
Every once in a while the staff at Knoxville Comprehensive Breast Center comes across a great article that we really feel like we should share. Breast Cancer.Org just published the mostintriguing article regarding diet. The word diet can cause a bit of anxiety all by itself, the following article however discusses eating habits that can be good for you.
Eating Unhealthy Food
Diet is thought to be partly responsible for about 30% to 40% of all cancers. No food or diet can prevent you from getting breast cancer. But some foods can make your body the healthiest it can be, boost your immune system, and help keep your risk for breast cancer as low as possible. Research has shown that getting the nutrients you need from a variety of foods, especially fruits, vegetables, legumes, and whole grains, can make you feel your best and give your body the energy it needs. [pl_button type=”primary” link=”http://www.breastcancer.org/risk/factors/unhealthy_food” target=”blank”]Read More[/pl_button]
As the leaders in Breast Cancer treatment and screening in East Tennessee, KCBC strives to bring our patients the most relevant information. We are committed to sharing great articles and information from other top medical providers.
Recently we came across an outstanding article form our friends at (SBI) The Society of Breast Imaging. The article addresses the age old question of “Do I really have to have a breast exam”?
Racial Disparities in Breast Cancer Screening
By: Dr. Sadia R. Choudhery
I get this weird phone call every July from my mom. “Do I really have to?” “Yes, mom, you do. Each and every single year.” My mom absolutely abhors mammograms, and she calls me every summer asking me if she really needs her annual mammogram, especially as she grows older. Her explanation is always that none of her mammograms have ever been positive and that her four sisters and my grandmother did just “fine” without ever having had regular mammograms. She is absolutely correct in saying that. Growing up in a South Asian household, regular “anything” (dental cleanings, annual checkups, mammograms) was an anomaly. Regardless, my mother is absolutely wrong in thinking that her oldest daughter (i.e. me) would ever give her a “pass” on her annual mammogram.
With so much contradicting information about when to screen and how often, it has become perplexing for patients to grasp the gist of screening mammography. This is even truer in minority communities. Here are some insights on racial disparities in breast cancer screening:
• African American women have an up to 42% higher rate of breast cancer mortality READ MORE
The Boutique at KCBC is excited to share information about the launch of “MYFORM” a new innovative personalized fitting full breast form and partial form by ABC. It is instantly customizable and adjustable to your personal fitting needs after any type of breast surgery!
If this sounds like something that you may be interested in please schedule an appointment and join us next month for our special fit event.
We will be hosting this special fit event on Thursday April 21, and Friday April 22 from 9-3.
Call us to schedule an appointment at 865-583-1010. We would need a new prescription from your doctor if you are a new patient or if it has been more than one year since your last visit with us. We look forward to seeing you!
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ACR and SBI Continue to Recommend Regular Mammography Starting at Age 40
Both Agree With ACS That Mammography Screening Saves Lives and That Women Ages 40+ Should Have Access to Mammograms
WASHINGTON, Oct. 20, 2015 /PRNewswire-USNewswire/ — As our shared goal is to save the most lives possible from breast cancer, the American College of Radiology
(ACR) and Society of Breast Imaging
(SBI) continue to recommend that women get yearly mammograms starting at age 40. New American Cancer Society (ACS) breast cancer screening guidelines, and previous data used by the United States Preventive Services Task Force (USPSTF) to create their recommendations, state that starting annual mammography at age 40 saves the most lives.[pl_button type=”primary” link=”http://www.marketwatch.com/story/acr-and-sbi-continue-to-recommend-regular-mammography-starting-at-age-40-2015-10-20?mod=mw_share_facebook” target=”blank”]Read Full Article[/pl_button]
If you’ve been diagnosed with cancer, your doctor may recommend a surgical procedure known as a sentinel node biopsy. The purpose of this biopsy is to determine whether cancer cells have spread into the lymphatic system, a phenomenon most commonly associated with breast cancer as well as melanoma. Read on to learn more about what to expect if you’ve been scheduled for a sentinel node biopsy.
The sentinel lymph node is the one to which cancer cells from a primary mass are most likely to spread. Before performing breast cancer surgery, the surgeon will inject a special type of dye that helps indicate the presence of cancer cells into the lymph node. This node is then removed as a standard part of the mastectomy or lumpectomy procedure and the path of the dye analyzed to determine whether and how far the cancer cells have spread. If cancer is not present in the sentinel node, it means that the cancer has not yet spread. Where cancerous cells are present, more testing may be required to determine the extent to which it has spread and develop a treatment plan.
A sentinel lymph node biopsy is typically done under general anesthesia. After the use of dye to identify the sentinel node, doctors make a small incision in the armpit area to remove the node so that it can be tested for the presence of cancerous cells. This procedure typically requires a hospital stay, especially if you are having your cancer removed or other surgery at the same time as the biopsy. Return to normal activities largely depends on your individual health situation; your doctor will advise about what’s best for you.
This procedure is important since it lets doctors target and remove only those lymph nodes that need to be removed, lessening the likelihood of complications such as pain and swelling. According to research published by the American Society of Clinical Oncology, sentinel lymph node biopsy is as effective in preventing the spread of cancer as more extensive lymph node surgery.
The most common complications of this procedure are short term pain, swelling, and redness at the surgical site. You may also experience an allergic reaction to the dye used in the procedure.
If you have been diagnosed with breast cancer, talk with your doctor about whether a sentinel node biopsy may be right for you, as well as about any concerns you may have prior to having this procedure.
At Knoxville Comprehensive Breast Center, it is our mission to save lives from the disease of breast cancer. We’ll work with you every step of the way to ensure you get the safest, most effective care possible. Our medical team is comprised of dedicated breast cancer specialists, who will work with you to provide the individualized care you deserve. Contact Knoxville Comprehensive Breast Center today to schedule appointment.
KCBC patient is the first patient to complete breast cancer treatment at Provision’s Proton Therapy Center. Read story here.
Research published in the Journal of the American Medical Association reported by the AP suggests that “removing both breasts to treat cancer affecting only one side doesn’t boost survival chances for most women, compared with surgery that removes just the tumor.” To read this article click here
A recent study discussed the benefits for women 75 and older continuing screening mammography. To read the article click here.