Going off the grid
I confess. I have a strange relationship with Dr. Otis Webb Brawley.
Dr. Brawley is the chief medical officer of the American Cancer Society. Now, that’s a very mainstream position. And yet, I agree with nearly everything he says about mammography.
It just doesn’t compute! I’m so used to rolling my eyes and gasping whenever I read official ACS comments about mammograms.
But Brawley says things about mammography that every woman and doctor need to hear. I just wish I could take him aside and whisper one word: “Alternatives.”
So far, this word seems to be missing from his vocabulary. And it couldn’t be more important. Because every woman and doctor need to hear this too.
LOUD and clear…
We have breast cancer screening alternatives that are safer and more accurate than mammograms.
The importance of being flexible
Here’s Dr. Brawley on mammography. “Truth be told, it cannot avert all or even most breast cancer deaths.”
That’s astonishing! That’s the sort of thing you expect to hear from me. But you don’t expect it from an ACS official writing in the Annals of Internal Medicine.
In a recent AIM editorial, Dr. Brawly candidly notes several risks linked with mammography…
- Radiation exposure
- Breast compression pain
- False positive results
- False negative results
- False-positive biopsy results
Two new mammogram studies accompany Brawley’s editorial. Each study concludes with the same recommendation. A woman at high risk of breast cancer should get a mammogram every other year beginning at age 40.
In these studies, two conditions define high risk: extremely dense breasts, and a first-degree relative with breast cancer.
Now, these risk factors are not new to anyone. But every breast cancer expert is aware that mammography is inadequate at revealing tumors in dense breasts. So why in the world would they recommend mammograms to these women?
This brings us to that one important word. Alternatives!
More than two years ago, I told you about ultrasound breast cancer screening. And it just so happens that ultrasound reveals dense breast tumors better than mammography. And the added double-bonus: no compression, no radiation.
Ultrasound has one drawback. It can’t confirm tumor malignancy. In recent years, a technique called elastography changed all that. Elastography detects tumor flexibility. Benign tumors are soft and flexible. Malignant tumors are more rigid.
Ultrasound screening is widely available, of course. But ultrasound plus elastography is still relatively new, so it may be harder to find.
But it would be MUCH easier to find these combined techniques if Dr. Brawley and his colleagues would only recognize their existence!
Is that too much to ask? Sadly, it probably is.
Mammography is big business. And over the past five years, radiologists invested millions in upgrading to digital mammography. But the digital aspect only enhances the image. Radiation is still used. Breasts are still compressed.
So in spite of Dr. Brawley’s frank review of mammography, radiologists will continue to heavily promote it, and doctors will continue to call it “life-saving.”
Ladies, if you want a true lifesaver, you’re going to have to go off the mammography grid. You can start by checking online and searching “ultrasound,” along with the name of your town or city. And if you’re feeling particularly lucky, try typing in “elastography” too.
“Analysis of two Annals papers on benefits of mammography in younger women” Gary Schwitzer, Health News Review, 4/30/12, healthnewsreview.org
“Ultrasound Elastography Developments Lead to Increased Sensitivity of Malignant Nodes” Diagnostic Imaging, 3/4/11, diagnosticimaging.com
“Elastography Reduces Unnecessary Breast Biopsies” Science Daily, 12/1/09, sciencedaily.com