Early Detection Saves Lives: A New Study Urges Women to get Mammograms Early

In New York, experts predict 15,570 new cases of breast cancer to be diagnosed this year. According to the Centers for Disease Control, the female breast cancer incident rate in New York state was 122-124 per 1,000 in 2007, the most recent year available.

So what is the best way to avoid late detection of breast cancer?

"Finding breast cancer early significantly improves a woman's chances,” Dr. Alicja Goracy, Director, Breast Imaging Service, at Downstate Long Island College Hospital said. “The best way to accomplish this is by conducting breast self-examinations, having a mammogram and having your doctor do a clinical breast exam.”  

Dr. Steven Garner, Chairman of Radiology at New York Methodist Hospital in Park Slope, agrees that early detection saves lives. He says the most aggressive form of breast cancer is found in women between the ages of 40 and 50. 

“This is what we are seeing everyday in our practice, we are picking up cancer and it tends to be most aggressive in women over 40 and 50 years old,” Garner said. “I believe self breast exams are very helpful, it makes the woman become a partner in her own health and she will be more likely to go get a mammogram.”

He also explained that self-examination is the first line of defense for women.

“Many of the tumors are actually picked up by women doing their own breast exams. It would be a big mistake to do away with self-breast exams and mammograms at age 40.”

But, recent trends in breast cancer detection have wavered: To perform breast self-exams, or not? To get mammograms, or not? 

The worry about breast self-exams is that they may skew results into too many false-positive tests. Some who recommend fewer mammograms have suggested that over-screening leads to unnecessary invasive tests and undue anxiety.

However, the 2011 Breast Cancer Symposium of the American Society of Clinical Oncology overwhelmingly supports these preventive measures. The American Cancer Society agrees.

“While there has been ongoing debate about when and how breast cancer screening should occur, this study validates that women who undergo regular mammography screening present at earlier stages and often require less aggressive treatment than those who do not,” said Dr. Jamie Caughran, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, MI.

Caughran, who helped lead the research team for a recent study on mammography said women age 40 and up should use both methods for detection. High-risk patients should seek advice from their doctors about the age for and frequency of tests. 

Dr. Pond Keleman of the Ashikari Breast Center in and Dr. Garner agree that a mammogram should be preformed before the age of 40.

"I recommend women get a baseline mammogram at 35 and then get them annually after age 40,” Keleman said. “Studies show that screening saves lives. "

Garner said that improved mammogram technology and better equipment has ushered in an era of better readings of mammograms, which use less radiation. He also said his department at New York Methodist preforms 40 mammograms a day, 200 a week and a few 100,000 a year. He explained that the sensitive mammogram technology can help avoid uneeded biopsies and has lowered the number of false-positive results.

But Garner said, if a biopsy does need to happen, that the advances in equipment has greatly reduced the risk of breast disfigurement.

“Biopsies now use a very skinny needle, which is called a stereotactic needle, that is considered minimally invasive, and breast disfigurement is low,” he said.

There are also alternatives to mammograms, which use radiation. However, Garner did stress that “the benefits outweigh the risks” in terms of the radiation used in mammography, but women can now get screened by sonograms and MRIs. Garner said both of the alternatives are good and effective.  

He also said that if cancer is found in one breast it is a good idea to get the other screened.

“Frequently the lesions are bi-lateral, meaning they are in both breasts, although you might not be able to see them at the same time,” Garner said. “I don’t want women to get nervous, this is by no means the rule, but research does show that women who have cancer in one breast are at an increased risk.”

There has also been a push for breast preservation at NYM and doctors have been able to avoid mastectomies in some cases. But, if a breast does need to be removed, Garner explained, doctors have improved reconstructive surgery after a mastectomy.

“There have been great advances in breast preservation. Oncologists have been able to avoid mastectomies, but when they do have to occur the technology that developed has remarkable results,” Garner explained. “The woman can have a beautiful cosmetic result. Doctors use the woman’s own tissue to reconstruct the breast, and this avoids rejection issues.”

The Michigan study, completed this year with data from nearly 6,000 women with breast cancer, counters guidelines by the U.S. Preventative Services Task Force, which recommends generally that women get mammograms every two years beginning at age 50. The USPSTF notes that screenings should be determined on an individual basis. 

Among other findings in the Michigan study:

• Breast cancer in women younger than 50 was more likely to be detected first by feel than by mammography. Of the women whose tumors were found by feel, 40 percent were younger than 50.
• Overall, 65 percent of the breast cancer cases were detected by mammography, while 30 percent were detected by feel and the other 5 percent by other methods.
• For women diagnosed with breast cancer before age 50, 49 percent of the cases were detected by mammogram. Of those, 18 percent were Stage 2, and 4 percent were Stage 3.
• For women diagnosed with breast cancer before age 50, 46 percent of the cases were detected by feel. Of those, 50 percent were Stage 2, and 17 percent were Stage 3.
• For women over 50, 81 percent of breast cancers are detected through mammography.

In 2011, ASCO predicts 230,480 new cases of breast cancer for women, 2,140 for men, and 57,650 non-invasive cases. About one in eight women will develop breast cancer, according to ASCO.