Clearly, the answer is “Yes”.
In my experience of over 30 years in a professional career as a clinical breast radiologist detecting and confirming the diagnosis of breast cancer, screening mammography has made a significant change in improving the survival of breast cancer patients.
Why then, are there doubters and naysayers including physicians? Why then, during this month of October, Breast Cancer Awareness Month, are there so many articles on the internet stating that yearly mammography screening is not necessary?
Since the advent of modern day mammography in the late 1970’s and early 1980’s, we have experienced a decrease in the mortality rate from breast cancer by 30%. In the 1960’s when annual screening mammography was not performed, the annual 5 year death rate was 64%. Since 2010, the 5 year death rate has improved significantly to 99% if the breast cancer is localized in the breast and 84% if the regional (axillary lymph nodes) are involved!
The size of the breast cancer at the time of it being diagnosed also makes a big difference. Dr. Lazlo Tabar of Sweden, a world renowned breast radiologist, has conducted a number of prospective mammography screening trials. In one of his trials he followed over 22,000 women (50% of the Swedish national population), aged 40-69 for 34 years. The women with DCIS (noninvasive breast cancer) had a survival rate of 94%. Women whose locally invasive cancer was 1-9 mm (.04 to 0.3 of 1 in.) in size, had an 86% survival rate at 34 years. If the breast cancer at the time of diagnosis was between 15-19mm (0.6 to 0.7 of 1 in.), the survival rate was 66% at 34 years. And if the breast cancer was 30-49mm (1.2 to 1.9 of 1 in.) the 34 year survival rate was 50%. With this data, you can see that the size of breast cancer at the time of diagnosis makes a big difference in survival rates.
The average doubling time of a breast cancer is 1 year, therefore, to find it at its smallest size we have to screen every year. Keep in mind 80% of the women diagnosed with breast cancer each year in the U.S. have no family history of breast cancer! Being a woman and with the prevalence of breast cancer – over 232,000 new cases of invasive breast cancer and over 64,500 cases of DCIS with a total of 296,500 cases of breast cancer in 2014, and the estimated deaths from breast cancer in 2014 being 40,000 – all women should be considered at risk.
In the early 1980’s, women marched on Washington to raise the awareness of breast cancer screening and advocated for mandatory health insurance coverage for yearly screening. Since 2003 The American Cancer Society has advocated yearly mammography for women 40 and older as long as they are in good health. Consider this – 1 in 60 forty year old women get breast cancer, 1 in 50 fifty year old women get breast cancer, 1 in 25 sixty year old women get breast cancer, 1 in 12 seventy year old women get breast cancer, and 1 in 8 eighty year old women get breast cancer! It is unfortunate that the U.S. Protective Services Task Force (USPSTF) under the Affordable Care Act since 2009 recommends mammography screening to begin at 50 and that it be performed only every other year and that it should stop at age 74! It astounds me that the American Academy of Family Physicians supports this recommendation! This will give leeway to the private health insurers to withdraw yearly mammography screening coverage for women. This moves breast cancer care two steps backwards. The ultimate goal of the USPSTF guidelines is to save money, yet at what cost to human life? Their goal is to decrease the cost of in-office needle biopsies that have concerning imaging findings, yet are benign. They consider the anxiety of mammographic call-backs of indeterminate findings and false negative needle biopsy results a harm to women. They do not even recommend breast self-exam or yearly physical breast exams by your physician. However, in finding breast cancers with imaging findings suspicious for breast cancer, and in doing in-office needle biopsies, we are light years ahead of where we were in the seventies when women proceeded directly to surgery to have excisional biopsies for suspected cancers felt by surgeons on clinical breast exams. The yield of breast cancers were low on surgical biopsies (1 in 7 to 1 in 13) and most surgical biopsies resulted in late stage breast cancers. Late stage breast cancer is 13 times more costly to treat than early stage breast cancer. It is estimated that there will be 65,000 more women losing their lives from breast cancer if these controversial guidelines are adopted on a widespread basis.
So I ask women 40 and older, do you think yearly mammography screening is necessary? I have seen the difference when women skip a year in their screening if a breast cancer is brewing in their breast. A year does make a difference. And as you just read, the results of Dr. Tabar’s study show that size at the time of diagnosis has a tremendous effect on long-term survival.
Yes, I do strongly endorse yearly mammography for women age 40 and older.
Kamilia Kozlowski, M.D.
Clinical Breast Specialist
P.S. Christiane Northrup, M.D., a board certified OB/GYN is described as a physician visionary pioneer and leading author in the field of women’s wellness. In one of her recent blogs she posted that getting regular mammograms is actually more harmful because you are subjecting your healthy breasts to cancer-causing radiation. Of course, she states, that doesn’t mean you should never get a mammogram, sometimes they are useful, especially if you have a dream that you have breast cancer.
In view of the information in my article, REALLY?