Thursday, 23 January 2014 01:24


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The Debate Over Mammograms:

What Should a Woman Do?

Brenda S. Smith, M.D.

The U.S. Preventive Services Task Force (USPSTF) recently completed an evaluation of mammography as a breast cancer screening tool.  The task force recommended reducing the use of mammography due to the risk of radiation exposure and false positive findings that result in unnecessary biopsies and surgery.  The USPSTF recommended that for women who are not at high risk, mammograms begin at age 50 and then recommended mammogram every 2 years instead of yearly until the age of 74.  The USPSF also recommended against self-breast exams again citing false alarms and unneeded biopsies.


Getting Defensive

My first impulse was to get mad at the USPSTF. Breast cancer is the most common cancer I see in women.  Every woman it seems knows someone with breast cancer.  Breast cancer is being diagnosed in younger and younger women.  As a doctor who treats only women and who practices preventative medicine, I take breast cancer very seriously and I think you should too.  I certainly am not going to do less in the fight against breast cancer.  If what we are doing is not as effective as it should be, let’s change what we are doing.  Let’s find something better.

Getting Objective

I decided to calm down and begin looking objectively at breast cancer screening methods.  Over the years, I have had some concerns with mammography. Mammograms do expose sensitive breast tissue to radiation which can damage or mutate cells. Mammograms involve squeezing the breasts which is certainly undesirable in any woman, but is especially undesirable for the increasing number of women who have breast implants and is impractical or impossible in women with large breasts.  Mammograms only detect structural changes in the breast once the cancer has grown large enough to distort the normal breast tissue.  Mammograms have difficulty detecting inflammatory breast cancer – an especially aggressive form of breast cancer. Mammograms are not as accurate in young women or any woman who has dense breast tissue.  I’m hoping that the discussion over mammograms will open the door to improve breast cancer detection methods.

Taking Charge

So if self-breast exams and mammograms are now being doubted as the best breast cancer screening methods – should we do as the USPSTF is recommending and practically do nothing? You can probably guess I don’t agree.  I believe women should perform a self-breast exam monthly.  I take the time in my practice to teach each woman a proper self-breast exam and encourage her to do one monthly.  In my practice this has been very successful and helpful in detecting breast cancers.  I also believe in doing some type of breast imaging yearly, but I would have to agree with the USPSTF that the mammogram may not always be the best method to image the breasts.  Ultrasounds can be helpful and do not expose the breast to radiation or compression.  New 3D ultrasounds are being studied and offered to improve the accuracy of ultrasounds. Breast MRI’s also avoid radiation and compression to the breasts and can be very effective in detecting breast cancer, but are extremely costly, result in even more false positives than mammograms and are only covered by insurance in a small percentage of cases.  Another option is breast thermography.  Digital Infrared Thermal Imaging is a “touchless” test of breast physiology that can pick up subtle changes in tissue without exposing that tissue to radiation or compression.  It is an FDA approved technology that looks for areas of the breast that are “hot spots”.  A hallmark of cancer tissue is that it has an increased blood supply and an increased metabolic rate compared to the normal surrounding tissue.   In Breast Thermography this increased temperature is recorded by an infrared camera that takes multiple images of the breast.  Thermograms can be used to safely screen women for breast pathology and identify women who do need mammograms or additional testing.  It can be used in young women, women with dense breasts, women with implants and it can detect very early changes in breast health for a reasonable cost.  For more information on breast thermography, please go to

Breast Thermal ImageBreast Thermal Image

As usual, our generation is on the cutting edge of this issue and each woman will need to make a personal decision on breast screening.  Talk with your doctor and develop a plan.  Let’s use the mammogram debate to push for better more accurate methods of screening that do less harm.

Action Tips

  • Let’s be sure of one thing, detection of a cancer is not prevention.  To practice true breast cancer prevention, be aware of how genetics, nutrition, hormones, chemicals and stress affect your breast health. Talk with your doctor.  Read What Your Doctor May Not Tell You About Breast Cancer Prevention by Dr. John Lee.
  • Be the expert on your own body – do monthly self-breast exams.
  • Do annual breast imaging, but consider screening tests, such as, ultrasound, MRI and breast thermal imaging (thermography) as a breast health screening tools in addition to mammography.  Consult with your doctor to determine what is appropriate for you.
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