How Often Should I Have A Screening Mammogram ?

Only 20 percent of breast cancer occurs before age 50, 40 percent of breast cancer is found in women between 50 and 65, and 40 percent in women over 65.

Canadian guidelines for breast screening recommend that women over 50 have screening mammograms done every two years. This is based on the favourable studies mentioned below and other studies indicating that the death rates from breast cancer may be reduced by 20 to 40 percent by such screening.

The American College of Physicians and The American College of Obstetricians and Gynecologists follow these guidelines and there are similar guidelines in Sweden, Holland, Italy and England. In 1993, the U.S. National Cancer Institute issued new guidelines suggesting screening mammograms begin at age 50.

Other American groups disagree. The American Medical Association, The National Cancer Institute, and The American Cancer Society, suggest that women begin the screening process as early as age 40, with a physical exam and mammography every one to two years, or as recommended by their doctor. After age 50 these groups recommend a yearly mammogram.

What Other Screening Techniques Are Available ?

PHYSICAL EXAMINATION: The most important other screening technique involves a woman having her breast examined by a experienced doctor or nurse practitioner to check for lumps or other abnormalities. One study of 80 physicians at a university medical center showed that their ability to detect breast lumps in a silicon breast model was only fair averaging 44 percent of lumps detected. (Journal of the A.M.A. 1985, #253).

The same study showed that 71 percent of doctors felt that their medical school or residency training had been inadequate. Eighty four percent felt at least some need to improve their abilities in breast lump detection.

The Canadian study is the only study so far to evaluate the value of a mammogram over and above physical exam in women 50 years or older. The researchers found that although more cancers were detected in the mammogram group, the breast cancer death rate was no higher in the group that only received a yearly breast exam from a trained nurse or doctor, with no mammogram being done.

BREAST SELF EXAMINATION (BSE): Between 50 and 60 percent of breast cancers are discovered by women themselves either accidentally or through purposeful BSE. To be worth doing, BSE must be taught well and performed well. A new learning method called the MAMMACARE LEARNING SYSTEM enables women to teach themselves BSE in a way that is much more accurate than the usual type of BSE that is being taught.

TRANSILLUMINATION: Low intensity red or near infra-red light is shone through the breasts. The shadows and reflections of the light are then fed into a computer and made into a composite picture. This method is not as accurate as a mammogram in detecting small cancers, but is very safe and has no side effects.

The light exam may be useful for women with dense breasts, especially younger women, women with lumpy breasts and pregnant women.

The light exam can also be a useful adjunct to a good physical exam, either by itself or with a mammogram.

New Techniques

The August 1992 newsletter of the Breast Cancer Action group in San Francisco provided much of the information on new diagnostic tests for breast cancer contained in this section.

• THE BIOCHRON: Barry Hirschowitz has invented the Biochron, a kind of electrocardiogram of the breast.

Electrodes are placed on the breast and the electrical charges of breast cells are measured. Eventually he wants to develop a cheap device for home use. The whole procedure is painless and the skin is never punctured.

• BLOOD TESTS FOR ANTIBODIES - THE AMAS: Dr. Samuel Bogosh developed a method of screening for active breast cancer by testing the blood for antibodies.