AS A breast disease specialist and surgeon, I am very concerned about the current debate over the efficacy of early detection of breast cancer through mammography.
Most recently, the Feb. 2 issue of the medical magazine The Lancet featured an article that concluded there is "reliable evidence of fatality reduction" because of breast cancer screenings - a report in opposition to the findings in December of Danish epidemiologists Dr. Ole Olsen and Dr. Peter C. Gotzsche. While academicians argue, women may be dissuaded from scheduling their annual mammograms. The consequences could literally be dire.
Cancers found late will take lives.
Over the past few decades, we have seen the size of breast tumors decrease, we are finding breast cancers in earlier stages and the mortality due to breast cancer has fallen. Five-year breast cancer survival rates among women have risen from 75 percent to 85 percent in the last 20 years.
To what can we attribute this rise in survival rates? Advances in surgical techniques have made it possible to do more breast conservation than ever before, but the essence of breast cancer surgery has changed little over the past several decades. Certainly we now have more drugs in our cancer-fighting arsenal than in years past, but can we attribute the decrease in mortality to improvements in chemotherapy alone? No.
Mortality is falling largely because of earlier detection of breast cancer, and mammography is the chief reason for this. Breast cancer surgeons know that mammograms can help find cancer, and find it earlier. Mammograms help spot the cancers we cannot feel. This allows the surgeon the option to conserve breast tissue - performing a lumpectomy, for instance - rather than a full mastectomy.
The study by Drs. Olsen and Gotzsche remains open to numerous interpretations. The foundation of the report lies in an analysis of statistical data, which is different from real-life experience in the diagnosis and treatment of breast cancer.
In my practice, I have encountered numerous women - from young mothers to women in their later years - whose cancers were first discovered through mammograms. Because of early detection, they received the surgical treatment and chemotherapy they needed, reducing incidence of mortality and enhancing quality of life. Seeing these women in my office - healthy, vibrant, alive - is proof to me that mammograms work.
The trend in medicine continues toward prevention and early detection. That's why we continue to see enormous resources placed into improving mammography and developing new technology such as three-dimensional imaging, optical scanning breast imaging, MRI, ductal lavage and other techniques designed to discover cancers as early as possible.
Nevertheless, the controversy spawned by the Danish study is serious enough that some speculate that the nation's chief cancer Web site, www.cancer.gov, may be changed to say it is unclear whether mammograms save lives. The questions and debate aside, one thing is certain: Most breast cancer patients do not have symptoms. Mammograms do find cancers that otherwise would not be detected until significantly later.
It's right that conscientious physicians should examine and evaluate current methods of breast cancer diagnosis and treatment. But at the same time, we must keep using the tools that we have, tools we know to be effective. Let the study of this issue continue. But let's continue to encourage women to receive their mammograms annually.
Neil B. Friedman, M.D., is director of the Breast Center at Mercy Hospital in Baltimore.