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The value of mammograms and when to start screening has been a topic of hot debate over the last number of years. General guidelines differ between countries and between health care systems. Breast cancer is still one of the commonest types of cancer in our society. The chances of a woman developing breast cancer during the course of her lifetime is 1 in 9. Currently, the Canadian Cancer Society advises women to begin screening at age 50 and to undergo a screening mammogram every two years thereafter until age 69. The key term here is screening. Screening assumes that there are no other factors to consider in your medical history, and that you, or your physician, perform regular breast examinations. Many other risk factors exist which may suggest that screening should start at an earlier age, such as 40.
There have been many studies performed to measure the effectiveness of mammography. First of all, there is no evidence to suggest that receiving 20 mammograms over the course of your lifetime is harmful health-wise, uncomfortable maybe, but not harmful. It is also accepted that mammograms can detect cancers smaller than you can feel, but it cannot detect all cancers nor can it be used for prevention. This screening method also catches many false-positives, which must be proven false with a biopsy. Anyone who has gone through this process understands the anxiety it creates because not all lumps are cancerous. The debate then shifts to cost. As in all socialized heath care, the true costs are hidden and difficult to determine, so the illusion of "free" is propagated. Even so, in Ontario, the cost is still a bargain at around $60.
We ran our own large study in Canada about a dozen years ago. That study did not support the notion of large scale screening in perfectly healthy 40-49 year olds. It also reaffirmed that for screening purposes, a two-year interval was as good as performing the test yearly in the 50-70 year old group. Several American studies differed in their results. The Americans are much more aggressive with their screening yet mortality rates seem to be similar in both countries.
In my own clinical practice, I am a big advocate of patients knowing, examining and listening to their own bodies. For this reason, I advocate that women, or their partners, learn to perform breast self-examinations as a first step. Clinical examinations are done during physicals and anytime an unusual finding is reported by the patient. When we see an unusual lump, an ultrasound and biopsy are often arranged. If it turns out to be of no concern, I still follow this group with mammograms. Similarly, anyone with a family history of breast cancer at an early age, or whose family members carry the BRCA1 or BRCA2 genes, receives mammography sooner.
Magnetic Resonance Imaging (MRI) is sometimes used to distinguish between a small benign lesion and a cancerous lesion, and has been proposed as a method of early detection. Screening using MRI would be extremely expensive and as such is not used for this purpose. A newer technique is on the horizon state-side. It employs a laser beam to map out a probability map of suspicious areas. There is no squeezing, pinching or even bra removal required, but I somehow doubt we will see it here anytime soon. In the meantime, I encourage you to talk to your doctor about which strategy is best for you.
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