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Getting Clear on Mammography

If Daphne McNairy-a career woman, wife and mom of two young girls-had taken this advice (her own, actually) and remembered to make her health as much of a priority as her fam­ily, she believes her breast cancer may have been caught earlier. But a harried schedule left little time for annual mammograms and diligent self-exams. Today, a mastectomy and six rounds of chemotherapy nearly two years behind her, McNairy is on the other side of cancer. "So many women are always giving, always caring for someone else. But if we're not taking care of ourselves, we re­ally can't be there for someone else," McNairy says.

Ursula Bobo agrees. Breast cancer hadn't run in Bobo's family until her sister was diagnosed with the disease after having her first mammogram at the rec­ommended age of 40. This diagnosis panicked Bobo, she remembers. In her early 30s at the time, she im­mediately booked an appointment for her first screen­ing. When the results showed a normal scan, she took a deep exhale in gratitude and vowed to be better about regular self-exams and annual mammograms.

A year later, when it was time for her second year­ly screening, the results dealt a blow: breast cancer. "I think there's a perception among a lot of women that if there's no family history of breast cancer or if you are healthy, you can let annual mammograms slide," Bobo says. "In just one year's time, I went from a clean scan to an aggressive cancer that had spread throughout my left breast."

The message that both these women want to impart: stay on top of your health. Get an annual physical, go for your yearly mammogram starting at 40, combine this with regular self-breast exams and know your body. You owe it to yourself and to your loved ones.

The American Cancer Society (ACS) reports that an estimated 230,480 American women will be diagnosed with breast cancer this year, and 39,520 women will die from the disease. Found early, breast cancers are curable. Ductal carcinoma in situ (DCIS), in which the cancer is only present in the ducts of the breast and has not spread, is more than 99% curable. But early detection is critical.

While scientific studies first proved more than 30 years ago-and again more recently-that mammog­raphy is the most effective screening tool for detecting breast cancer, numerous misconceptions about the procedure and its effectiveness have swirled around in recent years.

Some of the latest controversy surrounding mammography is due to a 2009 report by the U.S. Preventive Services Task Force (USPSTF) that recommended that most women under 50 did not need annual screenings. Instead, the USPSTF said, screening for women in their 40s should be based on individual risk factors, and women ages 50 to 74 should be screened every two years.

This news defied the guidelines set in place by the ACS and long maintained by health professionals, who staunchly maintain that as a routine standard, all women should have an annual mammogram starting at 40 years old. While the USPSTF's recommendations left women scratching their heads over when and how often to get a mammogram, other common mis­conceptions surrounding everything from risk factors (no family history = no worries) to the procedure (it's painful and can cause women undue stress) have only complicated matters.

"Women are very confused, and the truth is, they have every right to be," says Patricia Sacks, MD, medical director at the Vasek & Anna Maria Polak Breast Diagnostic Center at Torrance Memorial. "There is a lot of misinformation floating around, but what we know with certainty is that mammography has long been shown to reduce breast cancer mor­tality by over 30%.  

Sacks, a radiologist with more than 40 years experience in the field, and other experts cite a long-term, renowned Swedish study conducted in the 1970s as proof that mam­mography is a valuable tool in saving lives. The Swedish Two-County Trial, which traced the impact of mammog­raphy on breast cancer mortality over the span of three decades, was the first breast screening trial to show a reduc­tion in breast cancer mortality from screening with mammography alone. It found a 30% reduction in breast cancer deaths among some 77,000 women ages 40 to 74 who were invited to screen. The screening phase of the study lasted about seven years, with 29 years of ongoing follow-up.

Since technological advance­ments in mammography have been made in the years after the study, many say the Swedish findings may actually underestimate the benefits of regular screenings. The Polak Breast Diagnostic Center, one of four located throughout the South Bay, sees 60,000 patients each year. Some 350 cases of breast cancer are diagnosed there annually. Since 1987, patients have received ultrasounds, MRIs and biopsies in addition to routine screenings.

Breast cancer survivors Bobo and McNairy were screened at the center. Along with Sacks, they too have heard similar reasons from too many women who don't make mammog­raphy a priority. "I tell people there's nothing to be afraid of in getting a mammogram," Bobo says. "You owe it to yourself and your family. I think it's selfish not to have it done."

Many women are worried about the procedure being painful. But Sacks says that each view taken during screening takes only a few sec­onds. "It's worth putting up with a bit of discomfort for a year of peace of mind," she tells them. She encourages women to plan their annual mam­mogram between periods, preferably around the same time every year, and to take an Advil one to two hours prior to the procedure.

Another common myth associat­ed with breast cancer? "People oper­ate under the illusion that if there's no family history, there's no risk of breast cancer," Sacks says. While it's true that having two first-order relatives (a sister, daughter or mother) with breast cancer equals a higher risk for the patient, seven out of eight cases of breast cancer occur in women with no family history of the disease.

Sacks encourages a risk assess­ment and an MRI for women if there is any reason to think they are at high risk for breast cancer. For patients whose risk is defined as being 25% greater than that of the community at large, insurance will generally cover the cost of an MRI.

"The truth is, we don't know all the factors that cause breast can­cer," she says. "Family history is one factor, but lifestyle choices-obe­sity, heavy drinking, etc.-are also believed to play a role."

When it comes to family history, the screening guidelines change. "If a patient's mother had breast cancer at 47, we would recommend the patient start having mammograms 10 years before that and continue until she is 85 years old," Sacks says.

Some women are simply afraid of getting a call-back from the radiologist. "A great myth is that if we ask a patient to have a biopsy, it means the tumor is cancerous," Sacks says. "But often the biopsy comes back negative."

Nationwide some 800,000 to 1.1 million biopsies are taken each year. For women who are called in for a biopsy, Sacks emphasizes the importance of a needle biopsy over a surgical biopsy. This way, doctors can see the tumor marker and know how to treat the cancer. Crucial information-since in most cases, a small breast cancer removed with a lumpectomy followed by radiation has long been known to have the same cure rate as a mastectomy, Sacks says.

"Even when the breast is removed, the reconstruction work today is just amazing. We've come a long, long way. Plus, some of the advancements on the horizon are very exciting." Sacks has been collaborat­ing for the past six years on a tool that, when introduced, promises to significantly reduce the number of biopsies. In the meantime, women must be proactive about breast health. Sacks reminds women at any age who feel a lump to see their doctor and have a mammogram.

Dawn Fuh, mother of three, had no first-order relatives with breast cancer. Today she's undergoing chemotherapy treatment after being diagnosed at Stage II. Fuh was diligent with routine mam­mograms and self-exams, and she found the lump between her annual physical and mammogram appointments. The center discovered that cells from the lump had already spread to her lymph nodes. Fuh underwent a lumpectomy and the removal of lymph nodes, and radiation will follow her chemo treatments. "I know people who say they haven't been for a screening in five years," she says. "My best advice is to not be afraid and to just go. It only takes minutes. It's worth the trip, and it could be a lifesaver."

Bobo's battle with breast cancer taught her to live her life to the fullest and to be grateful for every day, every new experi­ence. Years had passed since her mastec­tomy. Then one day in 2009, Bobo came across a knot in the same breast. It was the size of a pencil eraser and painful. Scar tis­sue from my surgery, she thought. But a gut instinct kicked in, and Bobo paid another visit to the center.

Her cancer had returned. A lumpecto­my, chemotherapy and radiation followed. Today, two years later, Bobo is again can­cer-free. A butterfly and pink ribbon tattoo reminds her to be free and to not carry the weight of the world on her shoulders.

"I take each day as it comes," she says. "I don't always feel 100%, but I'm glad to be alive and well, and every chance I get, I encourage other women to be proactive with mammograms and stay on top of self-exams. Never take for granted a lifetime of living healthy."

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