Mammography versus clinical exam?

Sep 28, 2000

So will this information keep older women away from the mammography suite in droves? Not if breast cancer advocacy groups have any say.

In an official statement, the Canadian Breast Cancer Network said its representatives view the study "with caution and advise that women not believe that this announcement is exciting new evidence that women now can choose one versus the other. Many [breast cancer] survivors credit mammography with saving their lives by finding minuscule tumors that were not palpable through breast examination."

Susan Stanford is one of those women. The corresponding secretary for the Alamo Breast Cancer Foundation in San Antonio, TX, Stanford was treated for breast cancer nearly six years ago.

"As a breast cancer survivor whose tumor was found by a mammogram, I, to this day, know that [mammography] saved my life," Stanford said. "I do BSE classes and I tell them how important a mammogram is. I show them the sizes of lumps that are found by BSE, clinical exam, and mammogram. As a survivor, you can’t tell me that finding cancer early [with mammography] is not important."

When the study was released, Stanford was attending a regional meeting of the Breast and Cervical Cancer Control Program, administered through the Centers for Disease Control. Stanford said mammographers in attendance were "livid" about the news, and planned to draft a response letter to the Journal of the National Cancer Institute.

In the meantime, Stanford said the foundation has fielded several calls on their help line.

"The women here are confused and don’t know what to believe at this point," she said.

Whether the confusion is widespread is another matter. A recent survey in the Archives of Medicine found that most women in the U.S. do not understand the mammography controversy. The majority said cost was the major point of contention in the debate, rather than the scientific discourse over breast screening's benefits.

CJ Taylor of the Puget Sound Komen Connection, a Seattle-based affiliate of the national Susan G. Komen Breast Cancer Foundation, said that her organization had not received any inquiries on the study from its members.

The Susan G. Komen Foundation has taken the middle ground. A statement released on the organization's Web site urges members to keep in mind that "one study is not enough to change public health policy," but "this study highlights the need for better methods of early detection of breast cancer."

Better methods that include a thorough physical exam, something that older women, and their healthcare providers, would do well to pay more attention to.

"We have tried to point out to women that a good physical examination takes time, involves a visual component, and meticulous palpation of every part of the breast," said Dr. Anthony Miller. "Institutions can help in upgrading the skills of their practitioners by arranging for post-graduate training [in CBE] with skilled professionals as the teachers."

By Shalmali Pal
AuntMinnie.com staff writer
September 29, 2000

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Mammography-screened patients have better breast cancer outcomes, April 27, 2000

Danish mammo study reviewed: right questions, wrong answers, January 17, 2000

Screening mammography minimally beneficial beyond age 69, December 8, 1999