Mammograms and 40-something Women

FRIDAY UPDATE: I've been trying to estimate how many women in their 40s are diagnosed by mammogram and haven't been able to find that number. But I did e-mail Dr. Robert Livingston, my former medical oncologist who is now in Tucson, and he said he has never seen that data. 

However, he said he consulted with a colleague and their estimate is that about 50 percent of women diagnosed with breast cancer are diagnosed by mammogram. But he said this percentage would be much lower for younger women and higher for older women. 

All the discussion about the new mammography guidelines put out by a government panel has had me thinking. 

After all, I was diagnosed at age 43, by a routine mammogram, so how can I feel OK about guidelines that suggest waiting till age 50 for routine mammograms? If that had been the guideline 11 years ago when I was diagnosed, I'd probably be dead now. Because I had no symptoms and no family history. 

So I started wondering how many American women are actually diagnosed with breast cancer in their 40s every year, and by doing some math using NCI statistics, came up with 31,000. 

That's about 16 percent of the total--192,000 or so American women--diagnosed each year. 

Now, I need to find a statistic for how many of those women were diagnosed by mammography. If anyone has this number, or even a reasonable (evidence-based) guessimate, please e-mail me. 

What I want to know is the number of women whose cancers, like mine, were found by a routine mammogram when they had no symptoms of any kind. 

@ Jeanne Sather 2009.  

Comments

[carver]

That's a really good question Jeanne. I'll see if I can find an answer.

I am in the middle of mammography nerves because I had my routine screening and got a call yesterday that I need additional diagnostic work-up. I'd be more worried if this hadn't happened last year and I had a benign cyst. Also my March PET/CT scan had densities in both breasts with mild FDG uptake so it's not unexpected.

The reason for this long comment is that I think it would probably be more cost effective with someone like me to go straight to the ultrasound which is what I ended up with last year. Instead I got the regular screening mammogram and am going the the dog and pony show yet again where they do a diagnostic mammogram and if it's like last year they'll go ahead with an ultrasound since there is something that needs a closer look.

I don't have my appointment yet but it annoys me to be doing the same process two years in a row where it seems like they could skip the routine mammogram and go in for a closer look up front.

[carver]

Jeanne, I don't know if this answers your question but I think it sort of does:

"Mammograms do identify lethal breast cancer in women in their 40s, the panel acknowledged. When the findings of previous mammogram studies were combined, it showed that women in that age group who undergo screening are 15 percent less likely to die of the disease than women who are not. But the analysis found that 1,904 women in their 40s have to be screened to prevent one breast cancer death, compared with 1,339 women in their 50s and 377 women in their 60s.

For women in their 40s, the panel said, mammography should be limited to women who have been identified as having a high risk of developing breast cancer, which kills about 40,000 US women each year."

I got that quote from this article:

http://www.boston.com/news/health/blog/2009/11/delay_routine_m.html

In other places (Washington Post is where I got this but it's also in other articles I read):

"For every 1,000 women screened beginning at age 40, the modeling suggested that just about 0.7 deaths from breast cancer would be prevented, while about 470 additional women would receive a false-positive result and about 33 more would undergo unnecessary biopsies."

Sorry this is getting so long but one reason I compare this to asymptomatic PET scans for advanced melanoma patients is statistically some studies show they don't improve the odds. However, I know people who wouldn't still be here if PET hadn't shown tumors that were still small enough to surgically remove. One woman even with PET was borderline in terms of whether it was too big to remove from liver and just made it in time for surgery. So much as you feel you'd be dead without a mammogram she feels she'd be dead without a routine PET. I find it all very confusing because we are all individuals and of course our lives matter. It's just hard to know sometimes what to make of large population study findings.

[jeanne Sather]

Carver--that's really good info, thanks.

The number of false positives is pretty shocking--that suggests to me that we need a better tool than mammograms. The unnecessary biopsy figure is one I can live with.

Or maybe the people who read mammos need better training? Any experts want to weigh in here?

[Leah Lin Jones]

Hi Jeanne.

Quick background: At 42 years old mammo showed calcifications, which turned out to be DCIS in left breast. Breast conserving lumpectomy with clean incisions and negative lymph nodes. Radiation. One year later, annual mammo showed calcifications in right breast. Three excisions later (that's three surgeries) finally was able to get clean margins but found two unseen tumors and I have Stage II, lymph negative cancer.

I have been vegan over half my life, never smoked, social drink maybe once or twice a year, run everyday, no family history.

Two points to my post: (1) the mammo probably saved my life. But, I have very small dense breasts and although I have started a Tamoxifen regime I am holding off on radiation/chemo until I can get an MRI. Because the tumors I have didn't even show up in the mammos there is a chance that I have cancer in my breast tissue that will never be detected by self-exam (never had any symptoms, lumps) and won't even be indicated by mammos.

(2) From what I understand MRI is the best tool for dense breasted women. And, insurance rarely pays for it (but they will pay for Viagra - don't get me started!!!). I loathe the idea of surgry and cutting parts off/out of my body and may have to consider mastectomy depending on the MRI.

Thanks for the opportunity to put this out in the blogsphere. Hang in there my lady and thanks for your blog.

XO

LLJ

[Stephanie]

I would like to know what YEAR the data comes from for the stats in a post above.

Even Dr. Love was citing mortality rates from 1999 and 2003 studies as part of her rationale for going along with the gov. task force guidelines! I was appalled. This does not take into account the wide use of Herceptin and other new drugs along with better hormonal therapies, PLUS the early detection effort.

Numbers can be quoted, but are they really the most relevant ones?

[jeanne Sather]

Stephanie--I can look up the date for the stats I used, but they are probably five to 10 years old. I don't know why "they" can't get this kind of info more quickly.

[Karla]

I have mixed feelings about this. I was diagnosed with invasive ductal carcinoma just before age 42 as the end result of a mammo. But it turned out that my cancer was extremely lazy and slow-growing and even though I don't feel doubts now about how I treated it (lumpectomy and radiation), I do sometimes wonder if it was ever that big a threat to me. The thing is, how to know?

It's all so confusing. Young women do get breast cancer, and it can be very aggressive when they do, but do we really want to scare all young women into thinking they're more likely to get it than older women? Do we really want to start screening them with mammos even younger, and possibly create a self-fulfilling prophecy with all that radiation? Or are we finding a whole lot of stuff in women in their 40s that isn't that big a deal, along with that which is?

I can't help but wonder if, for every story about a woman who'd be dead today if not for a mammo in her 40s, there aren't as many stories about women like me. Or women for whom the mammo made no difference because they were doomed anyway.

And then there are the BSE guidelines. My surgical oncologist told me she doesn't recommend BSEs because she thinks that if you examine your own breasts every month, the changes in them are too gradual for you to be likely to meaningfully detect anything.

What I do think is that we've been oversold on mammos (which are better than nothing but have a lot of drawbacks) and on "early detection" as the be-all and end-all of cancer treatment. There are a lot of people out there right now who think that all you have to do is catch breast cancer early enough and it's curable...and they're outraged about these new guidelines...but they're also very wrong.

What to do, what to do?