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Mammography: 'Gold Standard' Could Use Some Polish

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WebMD Health News

March 12, 2001 (Washington) -- If nothing else, a new report on mammography from a top-level scientific panel shows this 'gold standard' of breast cancer detection has become a bit tarnished. Though the 40-year-old technique of X-raying the breast definitely saves lives, critics say many reforms are needed to bring the widely used tool into the 21st century.

"The perfect screening tool would find every breast cancer at a point where intervention would guarantee that a women would not die," Robert Smith, PhD, director of cancer screening services for the American Cancer Society, tells WebMD.

He says that mammography is a highly effective way of finding breast cancers, but it doesn't work for everybody. For example, it's more accurate in older women than in younger women.

"I still hold out hope that 20 years from now we'll consider mammography a barbaric, ancient technique," Ruth Shaber, MD, women's health leader for Kaiser Permanente in Northern California, tells WebMD.

Shaber worries that mammography directs potentially dangerous X-rays into vulnerable breast tissue. "Here we're shooting more radiation at [the breast], that's been proven many times to cause cancer in other tissues," she says. The risk of getting breast cancer from a mammogram runs between one in 100,000 and one in a million.

Even so, Shaber encourages women to have the procedure starting at age 40, and depending on the patient's risk factors, every year or two after that. It's one hedge against an epidemic that strikes 180,000 women annually in the U.S. and kills 40,000 a year.

Like Shaber, many experts may be ambivalent about the overall benefit of mammography, but so far, the numbers in favor have carried the day. Studies show the technique has been able to reduce the breast cancer death rate by 30% in women aged 50-70 by finding tumors early, when they're more treatable.

That's primarily why the highly regarded Institute of Medicine concluded, in a report released last week, that mammography is still the best way to detect and prevent breast cancer, even though the authors of the report note that there are 17 other promising technologies under development, albeit none have proven to be equally effective.

One hope is that the newer devices will find breast anomalies smaller than a grain of sand, which mammography can't detect. MRIs, or magnetic resonance imaging scans, already have that ability, and they're being studied in women who have a greater risk of developing breast cancer because they carry mutations in the breast cancer susceptibility genes BRCA1 and BRCA2.

"These are women who have a much, much higher probability of a diagnosis of breast cancer at a much earlier age," Smith says.

Another plus with MRI, says Barnett Kramer, MD, MPH, a director for the National Institutes of Health, is that women wouldn't have to be subjected to repeated X-rays from a young age. MRIs, Kramer tells WebMD, don't carry the radiation risk that mammograms do.

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