No Breast Cancer Screening For Women Aged 40-49

Screening DOES save lives...without a doubt...  That is NOT being debated.  Instead the NUMBER of lives being saved from screening mammograms is being debated.

At the end of the day, I think this is an important discussion BECAUSE.. WE OWE OUR YOUNGER SISTERS A BETTER WAY TO SAVE LIVES.  And if we sit here discussing how the current method of screening saved this one or that one's life, that's fine...HOWEVER, the larger question is ARE WE OFFERING WOMEN A FALSE SENSE OF SECURITY WHEN WE TELL THEM THAT ANNUAL MAMMOGRAPHY SAVES LIVES (especially for our 40 - 49 year old sisters)?

And you know what's missing from this discussion?  DENSE BREASTS...I mentioned it earlier and I will say it AGAIN.  DENSE BREASTS.   AND BI-RAD  SCORES.  Women need to understand the definition of BOTH those words and appreciate the context of those words and how they relate to themselves.  As I said earlier, and will repeat again.......When I do speak about breast cancer (which I rarely do in public because I am a VERY PRIVATE PERSON), I ask women if they know if they have dense breasts.  Most don't.  I knew I had dense breasts and was told in my 40's that mammograms were MEANINGLESS without a sonogram.  So during my 40's I had BOTH.  Often I had BI-RAD 3 score results.  BI-RAD scores were explained to me in detail and WHY they were categorizing my breasts that way.  EVERY SISTER DESERVES THE QUALITY CARE THAT I RECEIVED.  That's what Dr. Welch explains in detail in his book.  OUR HEALTH DEPENDS ON COLLABORATION WITH OUR DOCTORS. WE NEED TO EDUCATE OURSELVES AND WORK TOGETHER.  Going for a screening mammogram without further knowledge is DANGEROUS TO OUR HEALTH because we will never know if we are getting QUALITY care.

AND...I was diagnosed with a DIAGNOSTIC mammogram and sonogram.  I had a clean mammogram and sonogram at my ANNUAL SCREENING.  Several months later, (similar to Peter McMartin's wife) a lump was found and I went for the tests.  The DIAGNOSTIC mammogram MISSED my tumor.  The report referred to it as a BI-RAD 3...which was the same score that I received on all my other screening mammograms.  The DIAGNOSTIC sonogram labeled it a BI-RAD 4 and the subsequent biopsy confirmed it.  Both also missed the DROP of DCIS found in the MRI.  The MRI also had difficulty finding the tumor.  The DCIS was more strongly validated by the MRI than the tumor.

So, what I am saying and will say over and over again is that our younger sisters need to be more pro-active in understanding their bodies.  This requires letting go of the sense of security with screening.  Be it for our breasts or other parts of our bodies.  I read recently that  screening colonoscopies can miss up to 40% of tumors.  With all the prep involved and time it takes, are YOU comforted by THAT statistic?  I'm not.  And that's why there are researchers out there developing better tests!

I think, going forward, generations from now are going to look back at us and label us soooo naive.  Sure, we can comfort ourselves now and say, "Well, it's the best we've got for now at saving lives."  But, I will be bold and say, "Maybe not."  I often worry about my sisters who have the false sense of comfort that when they finish their screening, their health concerns diminish in importance, until their NEXT screening.  I worry about my sisters who aren't educated AND I worry about those who are educated and  who are NOT enlightened and the combination of BOTH, those who are educated and those who aren't yet BOTH are not enlightened. I question whether they are getting QUALITY care.  So, I will say, what saves the MOST lives is a combination of education, enlightenment AND quality care, NOT SCREENING MAMMOGRAMS!  AND THAT IS THE POINT THAT THE TASK FORCE IS MAKING!

VoraciousReader, yell away.  You are my BC bootcamp, and I love it.  Every single thing you say is and was absolutely true in my care.

Did y'all see the Komen site relative risk aggregator?  Wow, if I knew then what I know now.  Density increases risk as much as a previous cancer!!!  No one ever told me that.  And know your Birads score!  I still don't know mine, it's NOT LISTED on the mammo.  

Bottom line:  had I been educated properly, I would have argued for an MRI with a Birads 3.  Had they agreed to it, even every two years, things might have been different for me.  Maybe it would have been DCIS.  Maybe I would have saved a few percentage points in overall survival.

Could someone point to a site to help me understand birads better?  And could someone please tell me how to request that score at my upcoming mammogram?

Beesie, yes!  Perhaps a baseline mammography AND sonogram at age 40 for women of "average" risk is appropriate.  Then afterwards, based on history and risk, annual screening MAY NOT be necessary for women of average risk until age 50.  We have to move away from the idea that ANNUAL SCREENING, beginning at 40 is the be all, end all that saves soooo many lives.  That's the point! And if we can shift our thinking away from ANNUAL SCREENING, then we can shift additional funds to research that hopefully will then save the vast majority of other women's lives who are faced with aggressive breast cancers that DO NOT BENEFIT FROM ANY CURRENT METHOD OF SCREENING. We need a better method of screening AND a cure!  Ethically, it is a difficult concept to wrap our minds and hearts around...  Do we continue with an annual screening method that benefits few or look to spend those dollars saved on NOT screening towards research that finds a better way of screening or a treatment that will prolong the lives of many more women with aggressive disease?  In a perfect world there would be money for EVERYTHING and we wouldn't need to even entertain that question.   Sadly, that is the reality.  We owe it to all our sisters to begin thinking in a new direction.  What are our INDIVIDUAL RISKS and how do we go about achieving the best health care.  Perhaps "best" doesn't mean screening annually, but gaining the understanding of where you fit on the pendulum and getting the screening that is APPROPRIATE for YOU.    Again, that takes education, enlightenment and collaboration with your health care team...another word to describe that is QUALITY care!

 And while we're on the topic of screening and baselines...how many sisters and their partners have a baseline EKG?  I can't tell you how many sisters I know who RUN for their annual screening mammograms and haven't had an appointment with a cardiologist!  Ditto for their husbands!  I know I digress, but when we are talking about mortality risks it should be mentioned that for the majority of us, OUR RISK OF A STROKE OR DYING OF A HEART ATTACK IS GREATER THAN OUR CHANCES OF DYING OF BREAST CANCER.  And while this is a breast cancer website, I would be remiss if I didn't mention THAT!  Do the women here know what their blood pressure is and do they know what their risk factors for heart disease is?  Heart disease kills SIX TIMES MORE WOMEN THAN BREAST CANCER.  WE DESERVE QUALITY CARE and that begins with education and enlightenment.  So even though, we are all breast cancer survivors and are at higher risk of recurrence than the "average" woman, we also have to be mindful of our heart health:

http://www.womensheart.org/content/heartdisease/heart_disease_risk_quiz.asp

I was average risk (no family history) and my GP did a number of "routine" baselines when I turned 45: a mammogram, an EKG, addtional bloodwork, etc.  That mammogram was my first one ever and it detected my breast cancer. The EKG was fine.

VR, 

FWIW,I just checked out the screening test recommendations for women from UPenn:

http://www.pennmedicine.org/obgyn/health_info/timetable.pdf 

Blood pressure  is listed as part of general physical and cholesterol is listed as every five years starting at 45 for those without risk factors.  EKGs, baseline or otherwise aren't on the list.

I do have risk factors, including a strong family history for heart disease, so my screening including EKG started much earlier.  

The Red Dress campaign is doing a lot to bring  attention to  heart  health issues for women. The next wear red day is February 3, 2012.

Here's a nih site with information about heart health risks for women and how to lower them:

http://www.nhlbi.nih.gov/educational/hearttruth/lower-risk/index.htm 

There's a lot to know to keep ourselves as healthy as possible.

 All the best,

Meg 

I'm looking for a new family doctor because as I've written elsewhere on these boards I was so dissatisfied with the first one I got when I recently moved back to Canada.  I'm 53, the last time I had an EKG was before BC treatment in 1998, and I would think it would be a good idea for me to have another "baseline" EKG now, because both chemo and radiation can damage heart tissue.

 But the doctor I saw for my physical a month ago said "your family history and your own history show no risk factors for heart disease so I'm not going to schedule you for an EKG".  Also, she nixed a baseline colonscopy. It makes me angry. I don't think my requests are out-of-line. I am trying to be proactive on my own behalf because I don't feel like anyone else is going to be looking out for my health, and feel that so far the system here won't even ALLOW me to get the tests I want and feel are justified.

Maybe this will change when I find a more competent family doctor who is a better fit for me.

Doctors are service providers.  While they have specialized knowledge they should also be willing to refer you to basic screening and tests if you wish to do so and your requests are fairly reasonable and understandable.  

Mammograms are only the first line of defense and don't always help.  I know.  My mammograms leading up to my diagnosis were all "negative"; couldn't see the lump because of dense breast tissue.  But, let's face it: they are an integral part of the current screening/diagnostic process.

What scares me more than these new guidelines (and they do concern me on several levels) is a newspaper article I read recently, that stated there are a significant number of women in Canada who feel that - if they get annual mammograms - they won't get breast cancer.  I mean, how did these women miss what getting a mammogram is all about?

I agree wholeheartedly.  Women must read, learn and become their own best health advocates because - until they do, guidelines such as this and continued misconceptions about breast cancer (and other health issues) will only be damaging.