I was 44 years old when I went to the lab one lazy summer day for my annual mammogram. As I was leaving, the nurse said, “I see your doctor wants you to get a follow-up breast ultrasound, too.” One week later, after undergoing a lengthy breast sonogram and then a biopsy, my doctor called and gave me startling news: I had a 1.3 cm tumor in my left breast, and it was an aggressive form of invasive ductal carcinoma.
It takes about three to nine years for a single DCIS cell to grow into a lesion or tumor that is deemed visibly suspicious by today’s radiologic imaging technology. Since I reside on Long Island, a N.Y. suburb with inexplicably higher than national average breast cancer rates, I conducted monthly breast self-exams but never felt a lump. My tumor had been the uninvited invisible guest at all the breast feedings my daughters enjoyed. The doctor advised, “Don’t wait, you need to take care of this right away.” I can only imagine my outcome if, as the American Cancer Society’s (ACS) new delayed mammogram guidelines have advised, I waited until I was 45 to get my first mammogram.
Thankfully, I had gone to the same lab for all of my previous breast screenings, which enabled the radiologists to compare my results with earlier baselines; my first mammogram indicated breast density (which increases breast cancer risk, and can obscure tumors on mammograms), so I was thereafter referred for supplemental sonograms. Sonograms offer additional early detection against breast cancer, since they provide enhanced tissue visibility. At that last lengthy sonogram, the radiologist said, “I’ve reviewed all your earlier films, and I see this consistent suspicious image. It could be nothing, but we need to do a biopsy.” Having never felt the lump, this radiologist saved my life through early detection practices that mark breast abnormalities using mammography and sonography.
The new ACS recommendations, which delay first mammography screenings and end in-office breast exams, could end up killing women softly. An ACS report, which prompted the new screening guidelines, begins by acknowledging that “breast cancer is the most common cancer in women worldwide.” This year, the ACS predicts that more than 230,000 women in the United States will be diagnosed with breast cancer, and that 2015 will see 40,000 American women die of the disease. However, the organization scaled back its screening guidelines, citing evidence that the risks of misdiagnosis and unnecessary screening can outweigh the benefits of early mammography.
ACS’s new guidelines recommending that women delay their first mammogram until age 45 clash with the opinions of numerous cancer experts, such as Margaret I. Cuomo, author of A World Without Cancer: The Making of a New Cure and the Real Promise of Prevention. She believes that “early detection should be the core component of a bold, cancer-eradicating commitment.” Cuomo, in her 2012 book, says that until science can figure out how to prevent cancer, “early diagnosis and treatment” is secondary prevention. Plus, the well-respected National Cancer Institute recommends early detection, stating that “the earlier female breast cancer is caught, the better chance a person has of surviving five years after being diagnosed. For female breast cancer, 61.1 percent are diagnosed at the local stage. The five-year survival for localized female breast cancer is 98.6 percent.”
Breast cancer is like climate change—it is not going to go away. The National Cancer Institute recently predicted that breast cancers in “American women will increase 50 percent by 2030.” This sobering statistic makes it all the more disturbing that America’s three most influential cancer screening groups have wildly divergent baselines for the age at which a woman should undergo her first mammogram: In 2014 the American Congress of Obstetricians and Gynecologists (the only group listed here dedicated solely to women’s health) reaffirmed their guideline that mammograms should start at age 40; the American Cancer Society’s revision now suggests 45 (it was previously 40); and the federal government’s Preventive Services Task Force suggests the most delayed baseline screening for women, starting at age 50, and then only biannually. These divergent guidelines befuddle both doctors and the women they advise. The dangerous potential outcome of the ACS’s new guidelines could see more women undergo delayed, and perhaps deadly, diagnoses of breast cancer.
The ACS’s recommendations don’t align with their stated principles: “The best defense against cancer is finding it early, when it is easiest to treat. To help the public and health care professionals make informed decisions about cancer screening, we publish a variety of early detection guidelines.” In fact, the ACS advertises itself as an organization that helps “people take steps to prevent cancer or find it at its earliest, most treatable stage.” Really? Shouldn’t these early diagnoses protocols include baseline mammograms at age 40? The Centers for Disease Control and Prevention emphasizes that early screenings for cervical, colorectal and breast cancers can reduce death rates. ACS, in its own 2015 Annual Stewardship Report, concurred with CDC’s assertions, stating, “Evidence now shows that early detection can halt common cancers such as those of the cervix, breast and colon.” So why is the American Cancer Society limp on early detection?
In fact, why not increase early detection for breast cancer, using digital mammograms, breast MRIs, breast tomosynthesis, genetic screening, tumor protocol testing and ultrasound? Aren’t America’s women worth early detection?
In The New York Times last month, three women breast cancer experts (who have all, incidentally, received ACS professional awards for their work) rebutted ACS’s new guidelines, saying they “profoundly disagree” with the changes because the guidelines do not support early detection of breast cancer. Their collective response is based on incontrovertible evidence that mammography is the “only test that has been proven to…reduce the risk of dying from breast cancer, by up to 30 percent.” They also point out that the U.S. breast cancer survival rate is almost 90 percent, due in part to “early detection with mammography.” Significantly, these three breast cancer experts have announced that they will no longer be involved with the American Cancer Society.
Women now face a hard choice: Either accept the new ACS guidelines, or urge ACS to rescind them by withholding donations and sponsorships, and boycotting ACS events like Making Strides Against Breast Cancer. Women should demand that ACS support mammogram baselines at 40 years old, increase diagnostic testing and continue in-office manual breast exams. Only then will the American Cancer Society be forced to acknowledge that women’s lives matter by supporting early breast cancer detection. Women, demand your mammograms!
Photo via Shutterstock
Sophie Christman Lavin is a Ph.D. candidate and instructor in English literature at SUNY Stony Brook University in New York. A former assistant dean of academic affairs, she has taught undergraduate courses in both public and private universities. In addition to her M.A. in aesthetics and B.A. in philosophy, she possesses two French language certificates from the Sorbonne.