On the other hand, for both men and women who are equally at risk for colon cancer, screening and early diagnosis and treatment has led to a significant reduction in the number of more advanced cases of colon cancer diagnosed. So when it comes to colon cancer, early detection and removal of any precancerous polyps or early cancers really make a difference.
The same is true for Pap tests in women. Pap tests are also a great screening success story (read my recent blog on the value of adding the HPV test to your Pap test if you are 30 or older). Women who have an abnormal Pap test will have their abnormal cells diagnosed and treated early and are therefore much less likely to be diagnosed with advanced cervical cancer.
Australian researchers have found that as many as a third of women diagnosed with breast cancer may not need treatment. The researchers from the University of Sydney say they found that screening with mammograms is far from perfect and women often go on to have surgery and chemotherapy that is unnecessary because the cancers detected are slow-growing and not life-threatening. Unfortunately, our current screening with mammography -- even the more detailed digital mammography -- can't distinguish between slow-growing and aggressive ones.
I talked about some of the other potential risks of mammograms including radiation exposure in a column last February titled "Deja Vue: Questions about the Timing Of Mammograms."
What about women with a strong family history of breast cancer or those who have inherited the BRCA 1 or BRCA 2 gene? The USPTF was clear to address only women at average risk for breast cancer and not those women at particularly high risk.
For high-risk women, an MRI scan of the breast for breast cancer screening is thought to be more sensitive than mammograms and therefore more likely to pick up subtle breast changes or early breast cancer and it is not associated with ionizing radiation.
But we still do not have enough research on screening MRIs in young high-risk women to know if they are safe, effective, and worth the greatly added cost (both in dollars and in needless biopsies, scares, missed work, etc.).
I suggest that until we learn more about the benefits and risks of MRIs, every woman at high risk should talk with her doctor about the pros and cons of all available tests, including routine mammogram, breast ultrasound and periodic breast MRI.
Every woman's medical history and breast exam will be different and only when all aspects of a woman's history are taken into account can the best decision for screening be made. In the end, the decision should be made between a woman and her doctor.
In addition to a detailed conversation with your practitioner about the best way to be protected, all women should:
1) Be familiar with how your breasts feel and what is normal for you -- and do not hesitate to examine your breasts and to report any change or concerns to your practitioner
2) Continue to expect a regular breast examination by your practitioner, regardless of your risk factors.
3) Discuss the benefits and risks of routine mammograms with your practitioner if you are between the ages of 40 and 50.
4) Continue having a yearly mammogram starting at age 50.
5) Ask about getting a more sensitive digital mammogram or breast ultrasound if your breasts are very lumpy or dense