Large Study Recommends Mammograms Beginning at Age 40

Out of each 100,000 Maryland women, 122.6 to 124.8 have breast cancer, according to a 2007 study by U.S. Cancer Statistics Working Group. And 24.4 to 31.5 per 100,000 die from the disease.

Recent trends in breast cancer detection have wavered. To perform breast self-exams, or not? To get mammograms, or not?

The worry about breast self-exams is that they may skew results into too many false-positive tests. Some who recommend fewer mammograms have suggested that over-screening leads to unnecessary invasive tests and undue anxiety.

However, the 2011 Breast Cancer Symposium of the American Society of Clinical Oncology overwhelmingly supports these preventive measures.

The American Cancer Society and a nurse practitioner at the Herman & Walter Samuelson Breast Care Center at Northwest Hospital agree.

And a study out of Lacks Cancer Center in Grand Rapids, MI, shows that regular mammograms from age 40 can mean a patient endures less-aggressive treatment if cancer is found.

“While there has been ongoing debate about when and how breast cancer screening should occur, this study validates that women who undergo regular mammography screening present at earlier stages and often require less aggressive treatment than those who do not,” said Dr. Jamie Caughran, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, MI.

Kim M. Gallop, MS, CRNP, who is the nurse practitioner at the Northwest Hospital center in Randallstown, said she favors breast cancer screening for women ages 40 and above, "And earlier if there is an elevated risk factor," such as a family history, she said.

Gallop recommends a triad of services: An annual clinical breast exam by your heathcare provider, monthly self-breast exams, and a mammogram. "If all three of these variables are working together, it helps to promote early detection," she said.

Caughran, who helped lead the research team for the recent study on mammography said women ages 40 and up should use clinical and self-examination methods for detection. High-risk patients should seek advice from their doctors about the age for and frequency of tests.

The Michigan study, completed this year with data from nearly 6,000 women with breast cancer, counters guidelines by the U.S. Preventative Services Task Force, which recommends generally that women get mammograms every two years beginning at age 50.

The USPSTF notes that screenings should be determined on an individual basis.

Among other findings in the Michigan study:

• Breast cancer in women younger than 50 was more likely to be detected first by feel than by mammography. Of the women whose tumors were found by feel, 40 percent were younger than 50.
• Overall, 65 percent of the breast cancer cases were detected by mammography, while 30 percent were detected by feel and the other 5 percent by other methods.
• For women diagnosed with breast cancer before age 50, 49 percent of the cases were detected by mammogram. Of those, 18 percent were Stage 2, and 4 percent were Stage 3.
• For women diagnosed with breast cancer before age 50, 46 percent of the cases were detected by feel. Of those, 50 percent were Stage 2, and 17 percent were Stage 3.
• For women over 50, 81 percent of breast cancers are detected through mammography.

In 2011, ASCO predicts 230,480 new cases of breast cancer for women, 2,140 for men, and 57,650 non-invasive cases. About one in eight women will develop breast cancer, according to ASCO.

“Women of all ages presented with palpable tumors, highlighting the use of self-breast exam as an important public health measure,” Caughran said.

Get it together

Deb Kirkland, 42, the nurse navigator for Northwest Hospital's breast cancer center, said she was diagnosed with breast cancer 10 years ago—a young age for getting the disease.

She leads Breast Friends, a group she founded back then for women ages 45 and under who have the disease. Members are receiving care at any area hospital, and the group is funded by Northwest's parent company LifeBridge Health.

"Women should have a monthly self-exam and a annual clinical breast exam and an annual mammogram," said Kirkland, who at a young age discovered a lump in her breast.

"As long as you are aware of your breasts and any changes, you will be OK," she said.

"I always tell people treat your body as a temple, it’s the only one you have and early detection does save lives," she said. "People have to be in the know and know their own body."

To schedule screening at Northwest, call 410-521-5913. To find a doctor or for information about Breast Friends, call Northwest's Women's Wellness at 410-601-9355.

Free screening options

Northwest Hospital's breast care center also offers a program called Freedom to Screen for women who need help paying for mammograms and clinical screening due to low income, or issues with employment or insurance, Gallop said.

To learn more about this program, visit the website or call the breast care center at Northwest Hospital at 410-521-5913. Lisa Hamm, a public nurse practitioner, is the program coordinator.

Other examination options are the Maryland and Baltimore County's free screening program, or the St. Joseph Medical Center in Towson's free screening.