On Nov 17th (my mother’s birthday), there was a cataclysmic change in mammography.
The age at which a woman should have her first mammogram was changed from 40 to 50 and the frequency changed from every year to every-other year. Until now, it was believed that yearly mammograms were essential. As a radiologist and the son of a woman whose life was saved by mammography screening (breast cancer survivor since 1993), let me share my perspective on this issue.
I trained under Wendy Logan at the University of Rochester. She was one of the pioneers of mammography in the United States. Even in New York City, where I did my radiology residency, I was keenly aware of the bias against mammography. The 1980’s saw the beginning of worldwide screening for breast cancer. Since then, breast cancer rates have been dropping steadily. The war against breast cancer is being won (albeit slowly). Then, came the American College of Radiology’s accreditation of mammography. Countless lives have been saved (including my own mother’s).
The argument for using mammography is that cancers can be detected earlier, when tumors are smaller. This save lives. We find cancers while they are still small and this preserves breast tissue. But even under the existing recommendations, patients do not always follow them. Relaxing them will simply result in more patients finding larger, more deadly cancers at later stages. This is unacceptable.
Arguments about radiation dose and sensitivity of the test can be twisted to various ends. Keep in mind that a single CAT scan is the equivalent of more than 100 mammograms—and yet we hear about no guideline changes designed to reduce their use. (For the record, high quality MRI’s can do almost everything a CAT scan can do with ZERO radiation—a fact pointedly ignored by the media). On television, they talked about “false positives” and the “poor sensitivity” of breast self-examination. They suggested women stop performing self-exams. This is just wrong. We need to start with the basics. This change (and the reason it is being promoted before the study’s findings can be confirmed), is about money. Relaxing existing guidelines would save money as health insurance would have to pay for fewer preventative mammograms. They are trying to convince us that money spent on screening is a waste—that mammograms expose women to “unnecessary” radiation. I believe they are wrong.
We need to find breast cancer as early as humanly possible. Survival depends upon early detection. To do this, we need to use the best tools available. Self-exams can pick up cancers missed by mammograms and sonograms. This triple combination of mammography, sonography and self-examination are the tools we use today. They are not perfect. More advanced tools need to be added to the mix over time. I have been doing Breast MRI for more than 20 years (http://www.3tbreastmri.com) and we routinely pick up cancers missed by other tests. But we need to develop more tools for early cancer detection—not limit access to the existing ones.
I find it very interesting that a single study would be used to change the medical reality of 160 million women. It is clear that screening at yearly intervals is better than screening at 2-year intervals. Mammography is about 65% sensitive for cancer. This means approximately 35% of cancers will be missed at any given screening. Missed. So, in 1 of 3 women the cancer will potentially grow for two screening periods before it is found—up to 4 years under the new guidelines! Twice as long. This is why I encourage women to do their breast self-exam. I find it deeply disturbing that the war on breast cancer has been silently dropped (only days after Breast Cancer Awareness Month has ended). There are countless women whose cancer was picked up by self exam. And, sadly, many of these women actually had to fight with their doctors to get a biopsy diagnosis of cancer. The argument that you may biopsy 6 to 10 women to find a single cancer is valid. But I believe that this is reasonable to save that single life. What price shall we assign to a woman’s life—and who gets to answer that question? Medical professionals, politicians, insurance adjustors or the media?
Normally, new findings produced by studies such as this require further study before being adopted by larger medical societies. I find it very suspicious that the results of this study went directly to the news media before any larger organizations got behind it. To the best of my knowledge, NO medical body has approved these new guidelines at this point. I want to be on record as saying these new “guidelines” will cost lives and that many women will be needlessly disfigured because their cancers will be found later. We are surrendering in the war on breast cancer to save money—not to save lives (or breasts). Is this the beginning of other compromises in health care? I want every single person to stand up and say no. We must try to find every cancer as early as humanly possible.
My prescription? Further study and contemplation.
Dr. Philip Chao graduated Phi Beta Kappa and Scholar of the House from Yale University. He continued his studies at the University of Rochester School of Medicine and Dentistry, receiving his medical degree in 1983. After a transitional internship year at the Mary Imogene Bassett Hospital in Cooperstown NY, Dr. Chao did his residency in Radiology at Brooklyn’s SUNY Health Science Center (1984-1987), where he became Chief Resident. He stayed on to complete a fellowship in Neuroradiology (1987-1988). Dr. Chao has been interested in MRI technology since its very beginning—the first MRI scan took place in 1981 while he was pursuing his medical studies.
The University of Pennsylvania, where Dr. Chao was both a Body MRI Fellow (1988-1990) and a Neuroradiology Fellow (1989-1990), was at the heart of the development of MRI technology and Dr. Chao was able to work with pioneers in the field on the first GE Signa 1.5T (tesla) scanner. His advanced research and specializations complete, Dr. Chao left the University of Pennsylvania for a position as Director of MRI in Wilmington DE—a position he held for 14 years. Dr. Chao eventually left that position to create the best MRI center possible in the State of Delaware—using the very latest technology: 3T MRI (and later, high field MRI for larger and claustrophobic patients, which resulted in the addition of a 1.5T Wide Open MRI).
While 3T (tesla) scanners have been used for scanning research patients since 2002, these advanced, more powerful MRI scanners only became available for clinical use in 2004. Dr. Chao worked hard to bring 3T technology to Delaware and in February 2007, MRI Consultants, LLC began operating the State’s first 3T scanner. 3T is the newest horizon for MRI.