- Question from Arachne: There's been quite a bit of "news" recently suggesting that mammograms and breast self-examination are not particularly valuable in discovering breast cancer. Is this true?
- Answers - Cecilia M. Brennecke, M.D. No. Look to see who wrote the articles; they are not doctors, they are reporters. They are writing to get attention, and they do get attention. I'm married to a reporter, so I know these things.
- Marisa C. Weiss, M.D. But these reports were written in response to a re-dredging of data.
- Cecilia M. Brennecke, M.D. Those studies would have dwelled in obscurity; the public would not have known anything about them. One of the grandfathers of screening mammography was Swedish. The researchers who were questioning all the screening epidemiology were a couple of Danes, and these guys question everything and look for fault. But they never got written up in the New York Times before. It's frustrating to have something that you know works, and to have somebody telling women not to bother with it.
- Marisa C. Weiss, M.D. There is no perfect test, but these tests are still very useful, and when they are used in combination, we can do a very good job of early detection.
Cecilia M. Brennecke, M.D.
That's right. In the best hands, mammography is about 85 percent effective in picking up cancer. But if a woman feels there is something wrong with her breast and the test comes back showing that everything is normal, she may think she can ignore what she thought she felt. That's not a good idea; she needs to take things a step further. One of the hardest things about breast cancer is the emotional overlay. It's a very emotional part of the body. I have had women tell me they'd rather have their colons removed than have a biopsy of the breast. It seems obvious to me that if you touch your breasts, you will know more about yourself than if you don't touch your breasts. Women, particularly those under age 40 and not having routine screenings, should be very aware of how their breasts feel, and if they don't feel right, they should bring it to their doctors' attention. Younger women with breast cancer get picked up very late because they're not doing self-exams, and are not getting any screening tests because they're so young.
Mammography is of limited use if the breast tissue is dense, and there's no way to know how dense your breasts are until you've had a mammogram. Your breast can feel lumpy and sore and firm (cystic or fibrocystic), but when we do a mammogram, it may not be a difficult breast to interpret. Younger women tend to have breasts that are harder to interpret on a mammogram, but that's by no means universal. Thinner women tend to have breasts that aren't fatty. Fat is our friend on a mammogram. It helps us out when we're trying to find early cancer because it looks different than the way cancer looks.
On Wednesday, July 16, 2003, our Ask-the-Expert Online Conference was called Breast Cancer Screening. Cecilia M. Brennecke, M.D. and Marisa Weiss, M.D. answered your questions about mammograms, ultrasound, MRI, breast self-exams, physical exams by a doctor, and other topics related to breast cancer screening.
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