Health Articles - Breast Health
WOMEN - A CALL TO ACTION
Once women reach the age 40, a screening mammogram is a necessary part of their annual wellness program. The good news is that state-of-the-art digital mammography is providing images of unprecedented quality - much superior to the analog method that has been the industry standard. An additional sophisticated diagnostic tool, computer aided detection (CAD), is proving to be invaluable by automatically identifying and highlighting suspicious areas.
A proactive approach to health care is essential Visalia Women's Imaging Specialists has had digital mammography for over four years, and they use CAD on all mammographic studies. The technical aspect of obtaining the studies is integral to getting excellent results. Compression of the breast is critical to give the patient the full benefit of the procedure. Fortunately, compression time has been significantly reduced due to the speed of the digital unit. Our women mammographers are highly trained and have extensive years of experience.
We are now well armed in our collective war on breast cancer. Health care providers can have greater confidence in detecting breast cancer in its earliest stages when the prognosis is most favorable. In turn, patients can be afforded a better peace of mind about their breast health. Getting the word out to women is actively promoted by many organizations, but it is ultimately the individual's responsibility. For all the reasons women put off having their mammograms, none is a convincing excuse to deny themselves the medical advances available today. A proactive approach to healthcare is essential.
CONTROVERSY ON THE VALUE OF MAMMOGRAMS
Is mammography an effective tool in reducing breast cancer deaths? A recent Canadian study has again brought this subject to light with many articles in medical journals as well as in publications and media aimed at the general public.
This 25-year study involving 90,000 women concluded that screening mammography did not reduce breast cancer deaths. The study noted harms: 1 in 5 of the cancers found on mammography and treated was not a threat to the woman’s health and did not need treatment. It also suggested that screening leads to the detection of cancers that would never become clinically evident, which is defined as “overdiagnosis.”
Radiologist, Daniel B. Kopans, MD, Harvard Medical School, wrote a detailed rebuttal on the decades old effort to reduce screening mammography (The Oncologist, Feb. 2014). He noted the NCI 1993 study dropping screening for the 40 – 49 age group only to be reversed in 1997 due to randomized controlled trials (RCT’s). The “panel of experts” in the 2009 U.S. Preventive Services Task Force (USPSTF) issued new guidelines for screening beginning at age 50 and extended the interval to every 2 years. There was a misleading concern of “false positives” - - referring to women who are recalled for additional views after a screening reveals something that requires further evaluation. If these women were not found to have a malignancy, they were called “false positive.” The USPSTF concluded that avoiding recalls was more important than saving lives.
Dr. Kopans found fault with the methodology in the Canadian study which used an unblinded randomization process. His extensive assessment concluded that this study was an excellent example of a failure of peer review and should be withdrawn.
Dr. Frank McCully, breast imaging radiologist at Visalia Imaging, summarizes the view strongly held by his local colleagues and supported by the American College of Radiology: Annual screening mammography of age-appropriate asymptomatic women is currently the only imaging modality that has been proven to significantly reduce breast cancer mortality
Digital mammography with CAD is the gold standard in breast cancer screening. All mammography in the United States must be performed in concordance with the Mammography Quality Standards Act (MQSA) legislation and regulations published by the Food and Drug Administration. It is indicated annually for asymptomatic women age 40 and older who are at average risk for breast cancer and asymptomatic women under age 40 who are at increased risk for breast cancer. There is no defined upper age limit at which mammography may not be beneficial.