When the US Preventive Services Task Force (USPSTF) announced new recommendations for breast cancer screening, it unleashed a firestorm of controversy. Women across the country joined with many cancer organizations to condemn the new recommendations.
Briefly, the updated recommendations for breast cancer screening include the following:
– Delay mammography until women are 50, rather than beginning at age 40, and perform them every two years except in women with specific risks.
– Stop mammography screening in women 75 years and older.
– Discourage home self breast exams.
– Discourage of use of clinic breast exams.
Obviously, breast cancer screening is a very emotional issue. The opinion of the physicians at Nature Cures Clinic is that we both agree and disagree with aspect of the USPSC recommendations.
First, we applaud the fact that the new recommendations are based on the complete review of all the available scientific evidence. The USPSC did a thorough examination of all evidence available regarding the risks and benefits of breast cancer screening in women 40 and older.
Second, we think the USPCS added an important additional comment regarding the mammography recommendation. The Vice-President of the USPSC said that, “if you are a woman in your 40s …you should talk to your doctor and make an informed decision about whether mammography is right for you based on your family history, general health, and personal values.”
In other words, the decision to perform mammography should be based on the particular circumstances of the individual woman. That is patient-centered medicine, and it’s what naturopathic physicians have always advocated.
It is also important to keep in mind that mammography is not risk-free. Each mammography performed is estimated to increase the risk of breast cancer in a woman by 1% due to the radiation exposure. So, a woman who begins annual mammography at age 40 will have increased her breast cancer by 10% by age 50 because of the mammography procedure itself!
A more sobering way of thinking about this statistic is that some unknown number of women who now have or have died of breast cancer actually got their cancer from the radiation exposure of their annual mammography.
While we agree with that each individual’s risks and family history should determine the frequency of screening mammography, there are other aspects of the USPSC’s recommendations that we disagree with.
The USPSC recommends against self breast exams. They feel that there’s evidence that lumps found on self exam may actually lead to unnecessary, invasive procedures that ultimately harm more women than they help.
We believe that self breast exams should not be viewed simply as cancer screening tools. Rather, it is our opinion that self exams of any kind are about building body awareness. We feel it is important that women are instructed about self breast exams beginning early in their adult life. This process allows women to become familiar with the natural changes that occur in breast tissue over the course of their cycle and the course of their life.
Breast tissue changes in response to hormone fluctuations, dietary intake, stress and other factors. When women develop familiarity with those changes, they can also discover how changes in diet and lifestyle reflect in their breast tissue. Working closely with their physician, any concerning changes that do arise can be investigated more closely with ultrasound and even ultrasound-guided biopsy.
Overall, we agree with the USPSC’s recommendation to base mammography screening between ages 40 and 50 on the particular risks and history of the individual. We acknowledge that the scientific evidence does not support self breast exams as a cancer screening tool.
However, we feel that self exams as a lifelong practice for gaining body awareness is a valuable procedure for all women to engage in. Changes discovered help to educate women about normal changes in their bodies, and any changes of concern can be followed up with diagnostic procedures such as ultrasound that have less associated risk and greater diagnostic value than a mammography.
If you or someone you know would like to work with a physician who will develop a breast cancer screening plan tailored to your unique personal history, contact Nature Cures Clinic to set up a consultation today.