Mammograms: Returning To This Contentious Issue

Last week I pushed a hot button. Actually I pushed it twice, in the e-alerts 'A heated debate regarding mammograms' and '... Yet another myth concerning mammograms ' (13/08/03 and 14/09/03).

It's no surprise that members would have strong responses to the controversial realities of mammography - realities that fly in the face of the widely accepted 'safety' and 'necessity' of mammograms. Most importantly, in amongst the cheers and jeers I received, there was some very useful information for any woman who is weighing her options about breast cancer screening.

Do it yourself...but with training

A member named Linda started with the basics in this e-mail:

'BSE (breast self-examination) is definitely a major tool in prevention of breast cancer, BUT, as you point out, only when you know what to look for.

'In the case of small tumours, if you don't know 'what' to look for, it does no good at all. In my case, I didn't have a clue. It was my doctor who discovered the lump during an examination. I have since had tumours removed twice, but still wasn't clear on what to look (feel) for. Since becoming part of the S.T.A.R. (Study of Tamoxifen and Raloxifene) clinical trial however, I have been having my breasts checked every six months. Since each time was not always by the same person, I was able to see several different methods. One of the major problems with BSE is that women are not 'trained' in what to look for or more especially, what it might feel like if you do have a tumour. They need far more training sessions available (I couldn't find any in my area to start with), on how to do BSE, along with 'models' that a woman can actually 'feel' what some of the tumours might be like.'

Linda makes an excellent point. BSE is far more effective when women receive very specific training in how to do it and then how to recognise potential problems. For information on BSE training in your area, check with your doctor, or contact a local hospital. But keep in mind that along with BSE training, they may also heavily promote yearly mammograms. So if you don't want a mammogram, stand your ground!

The old guard

By and large the jeers were not many. The most articulate came from a member named David who shared the two e-Alerts with a friend of his (identified only as a woman 'in the medical field' - we'll call her Dr. W.), and he sent along her comments in his e-mail. I don't have room for her entire response, but this sentence sums it up: 'I would still STRONGLY urge you to advise all women close to you to HAVE A MAMMOGRAM.'

Dr. W. suggests a careful consideration of the studies I cited. She says, 'After these 'meta-studies' came out, some of the leading cancer centres and medical journals put out their own literature refuting many of these claims. It has been since reported that mammograms ARE necessary and MAY save lives - I believe the discomfort in the short term is WELL worth it when one's life is at risk.'

I agree that a careful consideration is in order when anyone (including me, of course) offers study results to emphasise a point. But Dr. W.'sassumption is that 'leading cancer centres and medical journals' provide the last word on this issue. In fact, what they provide is the ingrained, mainstream attitude that refuses to waver from the misguided conviction that mammograms provide the gold standard when it comes to breast cancer exams.

Dr. W. shares two individual cases in which mammograms proved to be useful. And I agree; there are many such cases where mammograms have saved lives. But that doesn't negate the fact that there are effective alternatives to the discomfort and danger of mammography and the needless rush to perform biopsies and begin therapies that often follow false-positive results of mammograms.

Unnecessary pain

A member named Zephyr wrote to offer one of the best reasons to use alternatives to mammography:

'My doctor did the 'this is what we do & best choice of screening' routine on me just last month. I've not had a mammogram to date and plan not to have one if at all possible! I am not well endowed and an older cousin, also not well endowed, had her muscle tissue pulled away (ripped off more like it) from the bone during a mammogram... that, at least in my eyes, was an unnecessary occurrence for her!'

Laser tag

'Have you heard of Imaging Diagnostics Systems?'

This question comes from a member named Emyrram, who adds: 'They have a new non-invasive laser procedure for breast examinations where they use lasers to produce a 3-d image. You can visit their website at www.imds.com What is your knowledge regarding this technology? Are the lasers harmful?'

I took Emyrram's advice and visited the web site, where I discovered another emerging alternative to mammograms. Imaging Diagnostic Systems, Inc. (IMDS), has developed a breast cancer exam method called computed tomography laser mammography (CTLM) breast imaging system. And Emyrran's description of how it works neatly sums up the technique for us in layman's terms.

I also found a number of published articles about CTLM, including one in Scientific American that describes the process as a combination of laser light and thermal heat that uses no radiation and produces a full colour, three-dimensional, cross-section view of each breast. The examination takes about 10 minutes, and - great news - it's 100 percent painless.

But does it produce more accurate results than mammography? Time will tell. While it's not yet available to the public, it is undergoing studies in four hospitals. I'll keep an eye out for the results of those studies and for more information about CTLM.

Sooner or later a breast cancer screening method will come along to knock mammography off its mainstream pedestal. That method could be CTLM, or it may be something we can't even imagine right now. Nevertheless, it will happen. And that day can't come too soon.