Mammogram controversy distracts from real issues

Sheila Vaudrey compares the need for women to have routine mammograms to the need for schools to call routine fire alarms. Sometimes mammograms can worry women and cause unnecessary stress. However, Vaudrey considers these routine procedures important steps in detecting breast cancer early, similar to the way routine fire alarms prepare children in escaping fire before it spreads.

“If it is (a tumour), it could be that one time out of 99,” she said, “but do you want to miss it?”

On Nov. 21, the Canadian Task Force on Preventive Health Care released new guidelines for breast cancer screening in women aged 40 to 74. The recommendations update previous guidelines from 2001.

The new guidelines recommend that women aged 40 to 49 not screen routinely with mammography and that women aged 50 to 74 have mammograms every two to three years.

The recommendations bewildered Vaudrey, who is 44 and a breast cancer patient.

“I’ve been shaking my head through this whole time and saying, ‘I don’t get this,’ because it doesn’t make sense to me,” she said.

Vaudrey feels that if women under 50 follow the guidelines, malignant tumours could spread very quickly before women discover them.

The Canadian Breast Cancer Foundation estimates that 20 per cent of all new cases of breast cancer in Canada will be diagnosed in women under 50. Further, their statistics show 10 per cent of all breast cancer deaths in Canada are in women under 50.

The new guidelines led to debates regarding mammography all over the media, said MJ DeCoteau, founder and executive director of Rethink Breast Cancer. She spent days following the release of the guidelines answering emails from confused women. DeCoteau emphasized that her charity supports personalized screening and informed decision making.

Vaudrey, who lives in Ottawa, believes routine mammograms play a crucial role in helping women detect breast cancer early. She disagrees with the new recommendations.

“Yes, you’re going to save money on tests that don’t need to be run. Yes, you’re going to have fewer people scared, thinking they have cancer and then it turns out they don’t. Yes, you’re going to subject them to less radioactive material,” Vaudrey said. “But most of us . . . will accept the risk of a false positive because it’s a huge relief to know your cyst is benign.”

Vaudrey would like to see women start routine mammography at age 40, at the very latest, and earlier if there’s any reason to believe a woman is at a higher risk of developing breast cancer.

“I don’t like the idea of leaving it later than that; I really don’t, especially now when I see what I’m going through,” said Vaudrey, who was diagnosed with breast cancer two years ago and is currently undergoing a second round of chemotherapy.

DeCoteau, 41, understands that many women under 50, like Vaudrey, are concerned about the new guidelines. When she launched the charity Rethink Breast Cancer in 2001, she wanted to engage a young audience and respond to the unique needs of young women going through breast cancer.

Rethink Breast Cancer, based in Toronto, is in support of the task force’s guidelines. The charity works with oncologists who helped DeCoteau understand the research supporting the recommendations. Studies show that more screening for breast cancer didn’t necessarily change the outcome, she explained. She feels frustration that mammography screening guidelines have become a controversy.

“We’ve been arguing about mammography for decades,” DeCoteau said. “I think it’s kind of deflecting from some important issues like . . . Why has there been so little improvement? Why are young women still dying of breast cancer? Why are any women still dying of breast cancer? Why are more and more young women getting breast cancer?”

Mammography is really good at detecting slow-growing, early-stage breast cancer; however, it’s not as good at diagnosing aggressive advanced breast cancer, DeCoteau said. The latter is what kills women.

In the mid-1980s, DeCoteau’s grandmother was diagnosed with breast cancer.

“She didn’t tell anyone about this lump that she had found and by the time she showed my mom, it was practically visible beneath her blouse,” DeCoteau said.

In 1988, her mother was diagnosed with breast cancer after a mammogram showed a cancerous tumour.

“(It was) very, very, very small for a breast cancer tumour,” DeCoteau said. “My grandma did well, with her late, big lump. My mom was dead within five years. Her breast cancer was caught as early as possible, yet she didn’t have a good outcome.”

Dr. Richard Birtwhistle, vice-chair of the Canadian Task Force on Preventive Health Care which released the new guidelines, doesn’t consider routine mammography comparable to routine fire alarms. While false fire alarms can inconvenience people, there isn’t a lot of risk involved unless someone falls and breaks her leg or something similar happens, he said.

“The issue is that a lot . . . of women are going to have false positives (with mammography),” Birtwhistle said. “Some of those women actually will go on to not only have a biopsy, but be told they have cancer and actually be overdiagnosed and have surgery or chemotherapy when, in fact, they never needed it.”

Birtwhistle and the task force didn’t look at the cost of mammography when they composed the guidelines. Instead, they studied the evidence surrounding the benefits of mammography and risk of breast cancer.

“Although we’re not recommending it for women 40 to 49 . . . we’ve actually extended the recommendation from 69 to 74. So, in fact, there would be more women, in that age group, getting mammography,” Birtwhistle said.

For women like Vaudrey, who still wish to start routine mammography prior to 50 years of age, Birtwhistle recommends they talk to their doctor. The guidelines won’t prevent women from having mammograms.

Meanwhile, rather than focus on the controversy surrounding early detection and mammography, DeCoteau hopes everyone will begin to pay more attention to breast cancer causes and treatment.

“There are problems with mammography,” she said. “Instead of saying, ‘this isn’t good enough; women are still dying,’ it’s just all about ‘well, we just need to screen more women.’ I don’t think that’s OK.”

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