The Blog

Making Sense of the Mammogram 'Debate'

This is why we worry about the confusion and complacency, and why we fear that the "debate" is giving many women -- even those who can afford it -- "cover" to stay away from the mammography clinic.
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Every three to four years, there is a very public "debate" about when and how often a woman in her 40s should get a mammogram. We worry that this "debate" (which is really less of a debate than different interpretations of the same information), is having unintended and dangerous consequences, fueling complacency and confusion that are keeping women away from screenings that could result in better treatment options and even save their lives.

The question isn't whether mammography in this age group saves lives -- we all agree that it does. Rather, the debate centers on whether enough lives are saved as a result of annual mammograms beginning at 40 to justify the known risks of false-positive diagnoses, missed tumors, exposure to low levels of radiation and anxiety. We worry that women hear only bits and pieces of this discussion and decide that maybe they can skip mammograms all together.

Our position at Susan G. Komen and that of most major cancer and medical associations has been clear for years: The best offense against breast cancer is early detection coupled with timely and effective treatment. We have 98 percent five-year survival rates for breast cancers caught early, before they spread beyond the breast. That five-year survival rate falls to 23 percent when breast cancer is diagnosed at the latest stages. This is why we continue to recommend annual mammograms beginning at 40 for women of average risk, and why we emphasize the importance of good communication with health care providers.

Last month, the American College of Obstetricians and Gynecologists added another factor to the case for screening when they issued new recommendations for annual mammography for women in their 40's. They referenced sojourn time, the period between the time that cancers can be detected on a mammogram versus the time that same cancer becomes symptomatic, e.g., develops into a lump that can be felt. This sojourn time is shorter in women 40-49, making annual vigilance critical.

Nearly every day, I meet a woman who tells me that her breast cancer was detected in her 40's and came "out of the blue." Many had no known risk factors for breast cancer. They led healthy lifestyles and were active. Many are or were mothers of young children, and grateful that a mammogram helped them get early and effective treatment (I know that feeling well -- my own breast cancer was detected by a mammogram when my son, Eric, was very young).

Almost every single woman I talk to tells me that she was glad she found out and was able to make informed decisions and feel more in control of her treatment and her life. For many of these women, the prognosis is positive. Women in their 40's who are diagnosed early have a 15 percent lower chance of dying from this disease.

This is why we worry about the confusion and complacency, and why we fear that the "debate" is giving many women -- even those who can afford it -- "cover" to stay away from the mammography clinic. We know why: women are busy, they're taking care of families or aging parents, they're working; they put their families first. That annual mammogram keeps falling farther and farther down the "to-do" list until months or even years pass. This is happening even to women for whom expense is not an issue. Alarming new numbers from a recent study show that as many as 50 percent of insured women are not getting regular mammograms.

These numbers are even more disturbing for women of color who are less likely to develop breast cancer -- but more than 30 percent are more likely to die from it.

This doesn't mean that we think mammography is the perfect technology. Far from it. I often marvel that mammograms -- so widely used across the U.S. -- is based on technology rooted in the 1950s. We can do better and that's why Susan G. Komen is funding research into new methodologies that will be more sensitive, more predictive -- that is, able to tell us whether abnormal tissue will turn into cancer or not -- more cost-effective and more widely available. Think of the implications for women's health if breast cancer screening could be as easy as today's simple test for cholesterol? That's where we want science to take us.

Komen alone has invested $17 million into early detection research, including 20 new grants this year to explore imaging technology, genetic testing, biomarkers and tests to help predict which women are vulnerable to different forms of breast cancer. Our partners are helping as well: Belk Department Stores is funding a three-year project to explore better detection through ultrasound.

Fighting breast cancer is everyone's battle, whether directly or indirectly, and we must keep up the fight. We know mammography isn't perfect, but it's currently our best weapon for early detection. We need to minimize confusion and provide access to screening and treatment for all women. We need to make it easy for women to take the right action. We must continue to support the best and most promising scientific research so we can bridge today's medical and technological gaps. Only then can we achieve our goal of ensuring that no one, anywhere, need fear a diagnosis of breast cancer -- ever again.