Recent debate regarding appropriate measures for breast cancer screening for women may have left you with questions about what sort of screening, if any is right for you. If you are confused, it is not surprising…there are so many differing opinions based on extensive medical research and experience and the medical community is not able to agree on what really saves lives in terms of screening measures. Screening measures for prostate cancer are also up for debate and this sort of debate is good. We need to evaluate the role of these tools and technology in making decisions regarding our health.
The Canadian Task Force on Preventative Health Care recently released their 2011 recommendations for Breast Cancer Screening for women aged 40 – 74 who are NOT at high risk for breast cancer. They are as follows:
Screening Mammograms May or May not be for you
|Age||Health Canada Screening Mammography Recommendations in 2011|
|40 – 49||a discussion with your doctor about your individual risk of breast cancer, along with the benefits and risks of mammography|
|50 – 69||Mammogram every 2 years|
|70 or older||a discussion with your doctor about your risk and how often screening should occur…again based on individual risk factors. Screening above age 74 is not recommended as potential risks outweigh benefits.|
Women are considered at a high risk for breast cancer if they fall into one of these categories:
- self or close family member tested positive for the genetic mutation for breast cancer
- family history of breast cancer
- received radiation to the chest before 30 years of age for the treatment of cancer or another condition.
Other important risk factors that you and your doctor may consider include:
- early onset of menses, age, hormone use – oral contraceptives and hormone replacement therapy, exposure to toxins – pesticides, herbicides, benzene, PCB’s, DDT, dioxins, cigarette smoke, alcohol use, obesity, child-bearing status, history of breastfeeding, sedentarism, breast tissue density
The use of Magnetic resonance imaging is not recommended as a screening tool. At this time I don’t have enough information to comment further on this as a potential method of screening, other than the obvious that it is expensive, time consuming and not accessible to most women. MRI screening is most often limited to those women considered high risk due to genetic risk factors, and is used in conjunction with mammography.
3. Clinical Breast Exams
These are done in office with your MD or ND, often during a routine physical examination, but are not recommended as a screening tool for breast cancer. There are limited studies as to the effectiveness of clinical breast exams and in one of three studies the Canadian task force included, the rate of false positives was much higher than that of mammograms.
4. Self Breast Exams
The task force also discouraged self breast exams as a screening tool. What I would like to challenge is that the intention behind self breast exams is damaging …you are looking for something wrong, touching and feeling the breast with concern, anxiety and fear of finding something. Instead I recommend a daily breast massage, with the intention of keeping your body healthy, and having an overall awareness about the healthy state of your breasts. Women should know their own bodies so they can be their own best health advocate. Check out our blog at www.kineticpatterns.ca for Daily Breast massage instructions. It only takes 2 minutes and you can accomplish this in the bath, your shower or before bed each day.
It is important to note that every screening method, mammography included, has its limitations. Mammography is accepted by the medical community as the screening tool with the most reliability for the detection of breast cancer but questions have been raised regarding:
- False positives that lead to unnecessary treatment, painful testing and psychological stress
- False negatives – missed cancers
- Over diagnosis and over treatment
- Increased exposure to radiation and trauma to the breast tissue
There may be safer, less invasive ways to monitor breast health. Some alternatives to mammography have been mentioned in the above review but breast thermography was not included. Thermography is one technology that is being promoted by some health care providers as a safe alternative for breast cancer in women that are not at high risk for breast cancer. It may be safer in respect to not compressing breast tissue or exposing the breast to radiation, detecting irregularities in breast tissue using infrared technology and a thermographic scan. If an irregularity shows up on a thermographic scan, the follow up recommendations are for ultrasound or mammography for further investigation though ultrasound may not be accessible due to conventional preference for mammograms. Thermography shows promise as a better tool for evaluating denser breast tissue that is present in younger women (under 50), of which mammograms are less effective. In BC, thermography is becoming more accessible through private clinics, though is not covered under standard MSP.
My initial intention for writing this article was to try to make sense of the information regarding screening so you can make an informed decision. It really isn’t that clear…there is no blanket recommendation that can or should be made, but each woman should evaluate their current health status and consider with their doctors or other health practitioners, what the best option is and whether screening is required. It depends on your personal beliefs and values as well. Screening is not prevention…limiting your risk factors, laughing, loving, eating well, exercising, finding meaning in your life, getting a good nights sleep in the dark, breastfeeding your children, avoiding exposure to chemicals…these are some of the rewarding actions will make a the biggest difference.