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Mammographic Screening for Breast Cancer – Who, When, and Why?

Mammography for screening of women older than 35-40 years of age was considered a no-brainer for many years and was advocated by all of the major support groups. Screening mammograms have always been felt to decrease the chances of dying from breast cancer by as high as 30% and when state governments have implemented stronger screening programs after approximately 10 years, mortality from breast cancer has decreased. Breast cancers discovered by mammography are smaller and of lower stages when compared to those cancers discovered on examination by patients or their doctors.

Recently more scrutiny has been applied to routine screening and its opponents have become more vocal. The US Preventative Services Task Force  (USPSTF) created a huge stir by suggesting the literature recommended screening with mammography for women between the ages of 50 and 74 be changed to every two years, selective screening before age 50 years, and no obvious benefit for older women. Switzerland upped the ante by not recommending mammographic screening at all (although I’ve heard it is still common for women there to do so).

The problem with mammograms (other than the discomfort) is that they are only 80% sensitive at finding breast cancers and often recommend biopsy for abnormalities that are not cancer (benign). Every biopsy recommended produces a cascade of fears and emotions that can have lasting effects often leading some women to forego any type of screening in the future. Mammography also exposes women to radiation which we know predisposes women to increased risks of brain cancer and leukemia.

The true answer to the mammography dilemma is that we need a better screening tool. Breast MRI is too expensive and nonspecific and breast ultrasound is useful as a supplement to screening but not so much by itself. Coming soon to a breast center near you is 3D-Mammography, Breast Scintigraphy, 3D-automated Ultrasound, and Contrast-enhanced Ultrasound. All of these techniques as they are developed now have too many problems to stand by themselves but are promising in selective cases.

In the near future we will be tailoring screening for each patient based upon breast density, age, prior biopsies and overall risk. This will will have benefits of cost-reduction and less unnecessary biopsies but will still leave some women feeling vulnerable. The good news is that the mortality from breast cancer is continually improving with more effective, less destructive therapies being developed each year. Its a very promising time for breast cancer care as more patients are being cured than ever.

 

One-third of Breast Cancer Patients Unemployed After Treatment

Recently published in the journal Cancer is a survey study of 1026 women with breast cancer under age 65 . After a follow-up of four years, 30 % of women who had been employed before their diagnosis of breast cancer were now out of work. Most of these women wanted to work and 31% were looking for employment. Getting chemotherapy was most related  to a woman being unemployed after a diagnosis of breast cancer.

The authors of this study state that the risk of post-treatment unemployment should be considered in giving chemotherapy, especially in low risk breast cancer patients. I would add that this has implications for women with a high risk of breast cancer from family history or other factors. If a high-risk woman is the sole care-giver for her family without other resources, a diagnosis of breast cancer might lead to a situation that could impoverish her and her family. This study’s findings also improves the economics of taking risk-reducing medicine and undergoing risk-reducing mastectomies for high risk women.