The Surprising Truth About Mammograms and Breast Self-Exams

Kristine Burke, MD
April 4, 2016

Mammograms and breast self-exams are one of the best ways to identify breast cancer early on, right?

Not quite.

Although experts used to recommend women do monthly self-breast exams religiously and have regular mammograms, conventional wisdom has changed a bit and we now know these tests are not all they're cracked up to be.

"But how can that be?" you wonder. Especially when your mother, sister, or friend found a lump and it turned out to be cancer.

Let's look at breast self-exams first.

Sure, anecdotally there are lots of women who find lumps, yet large studies have failed to show that women who neglect to do breast self-exams are more likely to die of breast cancer.

Plus, if you're constantly looking for lumps, it may actually increase the likelihood that your doctor will order a biopsy. It could also turn out to benign since 80 percent of lumps usually are.

So all that worrying would have been a complete waste of your time.

I tell my patients a better approach is to do two self-breast exams every 6 months. Instead of looking for lumps, I want them to become familiar with their own breast tissue. Then if something feels different, they can make an appointment with me.

Another benefit to this approach is that if I feel something unusual, I'll be better able to gauge if it's normal or something that needs to be looked into.

Is a yearly mammogram necessary?

The recommendations for when to start and how often to have mammograms vary greatly among the many different health organizations.

For example, the American Cancer Society says women should have a mammogram annually starting at age 40. The U.S. Preventive Services Task Force, however, recommends women start mammograms at age 50, repeat them every two years, and stop altogether at age 74.

Furthering the confusion, large studies have failed to show that regular mammograms reduce our risk of dying from breast cancer. You read that right. More cancers are diagnosed to be sure but the survival rates are not different. How can these both be true when we are told that breast cancer survival is improved when it's caught earlier? It may be because our treatments have improved so greatly or there may be other factors, but what's a girl to do until this all gets sorted out?

So here's the problem: your level of health is totally different than the next woman, regardless of age. So instead of making the same general recommendation for all of my patients, what I recommend and what my patients decide is unique for them.

For example, let’s say my patient doesn’t have any lumps but there’s been a change in her breast tissue. I may ask her to come back in a few months to re-examine her. It's possible that the change was simply a result of her menstrual cycle and nothing to worry about.

Sometimes lumps will be benign cysts as well. We may decide to drain the fluid or monitor it and see if it resolves on its own.

There are so many other lifestyle factors to take into consideration too, like genetics, family history, and the woman’s own medical history and health today. We also have to factor in the level of concern she and I both have based on the exam and her comfort level with certain approaches.

For example, since we know that radiation causes cancer, we may decide not to expose her to a mammogram every single year if she doesn’t have a high risk for breast cancer.

It's important to also look at how much value a particular test has. So if a woman has a low risk for breast cancer, the more likely a positive result will actually be a false positive.

Aside from mammography, breast thermography is one of the best tools we have available. Yet it’s used not to diagnose breast cancer, but to look for inflammation, which we know is a precursor for breast cancer. In fact, the risk of being diagnosed with breast cancer within 5 years of finding an abnormality is 40 percent. Thermography gives us powerful information so we can help you make changes to reduce your risk.

Mammograms are still one of the best ways to detect breast cancer early on, but they are just one of the tools we have available. At True  Health, we don’t order biopsies or mammograms just because we can. We use all of the information we have to decide as a team how to restore, protect and optimize your health.

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