On Women: Do I Need a Mammogram?

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Deborah Kotz

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"Since the word isstarting to get out," my friend Panina wrote several weeks ago in an E-mail to our close-knit book club, "I wanted to let you all know that I have breast cancer." When I was finally able to catch my breath, I couldn't help thinking, "There but for the grace of God..." Panina and I are both 37, became mothers in our mid-20s, and went on to have three kids. We're avid runners and favor vegetarian foods. What's more, neither of us has any immediate family members who were diagnosed with breast cancer. The National Cancer Institute's website (www.cancer.gov/bcrisktool/) calculates that our risk of getting breast cancer over the next five years is a minuscule 0.4 percent, which means that 99.6 percent of women like us don't. Small comfort for my friend.

I got a second shock when Panina later told me that her lump was detected on a screening mammogram. As a health writer, I know that cancer organizations years ago stopped recommending that women get their first baseline mammogram between ages 35 and 40. Though the baseline test was originally intended to give radiologists a point of comparison for breast tissue changes through the years, most find it more useful to compare a new image with the immediately previous one. And "women and doctors found it confusing, not knowing if [the test] should be done at 35 or 38 or 39," says Robert Smith, director of cancer screening at the American Cancer Society.

Clear payoff. Luckily for Panina, some doctors still urge women in their late 30s to establish that baseline. Her tumor was thus detected at an early, more curable stage. My gynecologist hasn't yet discussed screening with me, and I wonder: Should I have been given the option? Is there a possibility, even slim, that my life could be extended by having a mammogram tomorrow?

Probably not, says Susan Love, a clinical professor of surgery at the University of California-Los Angeles medical school and president of the breast cancer-focused Dr. Susan Love Research Foundation. "Your friend's case was 1 in a million," she tells me. "Don't confuse your emotions with science." What the science shows is that mammograms are a particularly poor imaging tool for finding tumors in young women; that's because both the tumors and breast tissue are dense, which Love compares to looking for a polar bear in the snow. If I get a mammogram now, there's a significant chance that the X-ray will miss any tumor I might have or that it will find something that leads to a biopsy but turns out not to be cancer.

So what can I do to protect myself? Every visit by a younger woman to her gynecologist should include a breast exam, says Love. And we should be attuned to any changes in our breasts. Most lumps, dimplings, or strange thickenings are found accidentally during a shower, say, and these should be checked out by a doctor. So, too, should any redness, tingling, pain, or nipple discharge. Even 20-year-olds shouldn't rely on rosy statistics to avoid having a suspicious finding biopsied or evaluated on an imaging test. "It's important to remember," Smith says, "that there are women who develop breast cancer at a young age, and there's no way of knowing who they're going to be." Meanwhile, there's no question that mammography benefits older women: An editorial in the current Obstetrics and Gynecology points out that regular screening reduces breast cancer death rates by 22 percent in women over 50 and by 15 percent in women in their 40s.

As Panina prepared for her first round of chemotherapy earlier this month, she gave me permission to take her story public. It would give her satisfaction, she said, if her experience were to make younger women more likely to pay attention.