NEPA Vital Signs - Summer Fall 2017 - 7

S U M M E R / F A L L 2 017

Feature

The Mammogram Debate:

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reast cancer screening is a hot topic
indeed. Whether you're at work, the
grocery store, the gym, or your doctor's office, the discussion is happening in
our community and in communities across
the country - and for good reason. Breast
cancer is a very common disease. One in
eight women will be diagnosed with breast
cancer. In 2017, more than 250,000 women
will be diagnosed with breast cancer. About
40,000 women will die from breast cancer
in the U.S. this year.
Despite these statistics, breast cancer is
a disease that, especially if caught early, is
very treatable. In fact, the five-year survival
is almost 90%. That is, out of 100 women
diagnosed with breast cancer, 90 of them
will live at least five years. While we certainly
strive for all women diagnosed with breast
cancer to live for five years and beyond,
these estimates are far better than other
cancers. For example, the five-year survival
for lung cancer is unfortunately only 18%.
So, why are the survival statistics for
breast cancer so good? There are two
reasons. First, doctors are very good at
treating breast cancer. Advances in surgical
techniques, radiation therapy, and chemotherapy have resulted in highly effective
therapies that are well tolerated by patients.
Second, thanks to mammograms, doctors
are able to detect cancers years before a
women would present with a symptom such
as a breast lump. Early detection plays a
critical role in breast cancer care.
Why the debate then? Well, since breast
cancer impacts so many lives, there are multiple
types of doctors who contribute to breast cancer
screening and treatment. In addition to cancer
doctors (oncologists) and surgeons, there are
family practitioners, internists, radiologists,
and of course, obstetricians and gynecologists.
There are national societies that guide the
practices of these medial specialties by issuing
recommendations on topics such as breast
cancer screening. Also, the American Cancer
Society and the U.S. Preventative Services Task

Should I Get Screened?

Annual screening beginning at age 40 saves
the most lives and years of life for women.
Force publish screening recommendations for
A mammogram is an excellent screenbreast cancer and other cancers.
ing test, and it's only getting better. The
advent of digital breast tomosynthesis,
It would be wonderful if there were a single, also known as "3D" mammography, has
unified screening recommendation that can enabled doctors to detect cancers even
be applied to all women. Unfortunately, the earlier than conventional mammograms.
guidelines of these professional societies do But no screening test is perfect. It is posnot necessarily agree on important issues like sible to miss a cancer on a mammogram,
the age at which a woman should get her first and mammograms can detect breast lumps
mammogram and how often she should get and calcifications that are not cancerous
mammograms thereafter. This can lead to con- but require a biopsy to prove they are
fusion both among patients and their doctors. benign. There is a small dose of radiation
from a mammogram; though the total dose
As a radiologist, I too have societies in my is much less than a CT scan.
specialty that issue screening guidelines. Both
the American College of Radiology (ACR) and
It's never too early to discuss breast
the Society of Breast Imaging (SBI) recom- cancer screening with your doctor. The
mend that a woman of average risk for breast discussion should include your family
cancer should get a mammogram every year, history of breast cancer, especially immestarting at age 40. An "average" risk woman diate family members such as a parent,
doesn't have a history of breast cancer herself, sibling, or child. This information can
a family history of breast cancer, a genetic impact the age at which screening begins
mutation (such as BRCA) that increases risk and how often it should be performed. And
of breast cancer, and has not had radiation of course, call your doctor if you have a
treatment to the chest before age 30.
breast lump, a lump under the arm, skin
changes in your breast, nipple discharge,
These recommendations are from leading breast pain, or any other concern regarding
radiologists in the field who, like me, make your breast health.
their livings reading mammograms and other
types of imaging studies. So, it may not be a
JOHN S. FARRELL, M.D., is a
diagnostic radiologist. He practices with
surprise that these societies are "pro-screenGeisinger Health System's Radiology
ing." However, it has been shown that annual
Department. He has been a member of
screening beginning at age 40 saves the most
the Medical Society for 11 years and is
LCMS's 140th President.
lives and years of life for women.
N E PA

VITAL SIGNS

Table of Contents for the Digital Edition of NEPA Vital Signs - Summer Fall 2017