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New Mammogram Recommendations

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November 24, 2009
	Dr. Gary Huber : Head Medical Ego

The U.S. Department of Health & Human Services just released their recommendation for the use of mammograms in breast cancer detection last week and it caused quite an uproar.  Allow me to present them as they appear on the government website so that there is no chance of misinterpretation:

The USPSTF (US Preventative Service Task Force) recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.

The USPSTF recommends biennial screening mammography for women aged 50 to 74 years (Grade B recommendation).

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.

All I can say is . . . wow.

While many groups see this as a careless attempt to save funds and put women’s lives at risk, as a medical practitioner, I have to say I agree with their findings.The recommendation is not surprising in light of all the evidence regarding mammograms; I just can’t believe they said it out loud.

You have to understand that the American Cancer Society has a strong relationship with the manufacturers of mammography equipment and so these strong ties have led to questionable health recommendations for women for years. I am delighted that finally a larger body of influence such as the Department of Health & Human Services has made a stand to push the agenda of women’s health out of the dark ages.

Mammograms are not very efficient at detecting breast cancer and as a tool they offer some significant penalties to their users. Each mammogram delivers 1 Rad of radiation to breast tissue which can actually cause damage to breast tissue. Each mammogram increases a women’s risk for developing breast cancer by 1 to 2 percent per mammogram and the effect is cumulative. The compression used to obtain an optimal view is not only painful but potentially hazardous as is may rupture small blood vessels around yet undetected breast tumors causing spread of tumor cells throughout the body. 

I also want to draw attention to the recommendation for “biennial” not yearly screenings for women aged 50 and above. This is every two years. And note that this is a “Grade B recommendation” meaning that it has the potential for moderate benefit.  A “Grade A recommendation” is one of high certainty that benefit is substantial. There are no Grade A recommendations in the field of mammography. 

So what are women to do? Are you left out in the cold to fend for yourself against the number 1 killer of women aged 40 to 55? No, of course not. There is a safe and simple technology that has been ignored by mainstream medicine, at least in the United States, for years.  Thermography has been successfully employed in Europe for years and is slowly gaining a foothold in the US. The Marseille Cancer Institute in France has been using thermography with good results for years. I want to be very clear that thermography is not a perfect test and further development is needed but it is clearly a valuable technology that is truly safe and beneficial. 

Thermography s a physiologic test that measures heat coming off the breast tissue. Tumors that may be growing in the breast need to develop significant blood flow to support their abnormal growth and this increased blood flow puts out increased heat patterns. These can be detected by a highly sensitive thermal camera. There is no radiation, no compression, no one even touches you. You simply stand in a cooled room in front of the infrared camera. Most insurance plans won’t pay for it (yet) but the cost is reasonable running in the $200 to $300 range.

Thermography has the ability to detect a tumor long before a mammogram. In fact the Marseille Cancer Institute published findings that in cancer patients in whom their first alert was an abnormal thermogram had a mean age of 45 years while those who’s first alert was an abnormal mammogram had a mean age of 65 years. 

Yes, further research is needed to uncover the best use of themography in breast cancer health but for now we know with certainty that this technology is safe, easy to use, low in cost and has been shown to be of great benefit. It is not perfect and will not detect ALL breast cancers but it does offer a screening option for women of all ages and has been shown to be an effective tool in women under the age of 50. And let’s not forget self breast exams. At least 90% of women who develop breast carcinoma discover the tumors themselves.

For more considerations and information as to why this latest USPSTF recommendations may be steering us in this direction, review the mammogram appendix to my free Breast Health e-book, 25 Ways an Empowered Woman Takes Control, (available free to all Healthy Alter Ego subscribers).

There you will find citations from the literature findings on mammograms and more information regarding the pros and cons of its use.

For those interested in thermography as a screening option, it may take a little homework to find practitioners in your area until the technology gains a stronger foothold, but I will tell you it is worth the effort.