Mammograms have been considered the gold standard in breast cancer early detection for decades. Despite limitations and risk/benefit concerns mammograms have detected breast cancers early and made a positive difference for a percentage of women diagnosed. The concern about false negative and false positive results of mammography has been part of the risk/benefit discussion over the past number of years and warrants review.
I am not an expert in diagnostic testing, but I am an informed woman in the recommended screening age in the province of Ontario. I am also a health promotion professional who has spent the last ten years educating young women about their breast cancer risk, breast cancer facts, symptoms and self-care strategies.
There is no routine breast cancer screening available for young women under the age of 40, and self-checks are the only early detection strategy available to them. One of the limitations to mammography is the failure to detect breast cancer in women, particularly young women, with dense breast tissue. As a result, the recommendation for young women is to know their bodies, know their breasts and check ’em often. Knowing how their breasts look and feel provides them with the opportunity to know their normal. Young women are then able to seek medical attention if they detect any unexplained or persistent changes in their breasts.
Early detection was also the goal of Breast Self Examination (BSE) promotion in the past, but research reviewed by the Canadian Task Force on Preventive Health Care reported that BSE, a formal or prescribed approach to examining your breasts, was not reducing deaths from breast cancer for women 40 to 74 years of age. Unfortunately, poor communication of the review findings did not clarify that knowing your breasts and the symptoms of breast cancer were still important and a compliment to mammography screening. This lack of clarity or confusion left a void in breast cancer education and women of all ages were put at risk.
There are risks with overdiagnosis (reported in the Danish study) including treatment decisions of identified pre-cancerous breast lumps. Women and health care professionals may react to the mammography results and cases, where monitoring may be indicated, are advanced to more aggressive treatment. Risks, along with any research limitations, need to be considered in reviewing the best guidelines for mammography screening, interpretation of results, stage of diagnosis and the protocols for treatment.
As concerns regarding routine mammography escalate and protocols change, the need for older women to be more diligent in knowing their own breasts becomes increasingly more vital. Interestingly, the Danish study did not find any ‘difference in incidence between screened and unscreened groups.’ Women often detect their own breast cancer, but the hope is to feel the breast lump when it is the size of a small almond not the size of a mandarin orange. Early detection messaging needs to be comprehensive so that women receive appropriate screening, understand their risk, know the symptoms, check their breasts, and watch for unusual changes.
Click here to read the Table of Contents for the series: Breast Cancer Screening, Mammography and “Alternative Facts”
The opinions expressed in this article are the author’s own and do not reflect the view of Cancer Knowledge Network or Multimed Inc.
Lorna is a Registered Nurse and Health Promotion Specialist. Lorna brings her public health expertise to her role as President of Team Shan Breast Cancer Awareness for Young Women (Team Shan). A national charity, Team Shan is named after Lorna’s daughter Shanna. In Shan’s memory, Lorna shares Shan’s Story and Team Shan breast cancer messaging with young women across Canada. Lorna has published and presents regularly on the issue of breast cancer in young women. Please visit Team Shan at teamshan.ca or contact Lorna directly at 519-421-3666 or firstname.lastname@example.org.