Local doctor makes case for annual mammograms

October is National Breast Cancer Awareness Month. Find more stories of courage, treatment and survival in the face of breast cancer at www.columbian.com/news/health/breast-cancer

o Kearney Breast Center at PeaceHealth Southwest Medical Center: 360-514-6161, swmedicalcenter.org/breast.

o The Vancouver Clinic’s Breast Care Center: 360-882-2778, tvc.org/specialties/breastcarecenter.ashx.

o Legacy Breast Health Center Salmon Creek: 360-487-1800, legacyhealth.org/breasthealth.

Breast cancer resources

o Pink Lemonade Project, a Vancouver-based nonprofit that provides support for breast cancer survivors through healing retreats, peer-to-peer support programs and breast reconstruction advocacy: pinklemonadeproject.org.

o Breast Friends, a Tigard, Ore.-based nonprofit dedicated to improving the quality of life for female cancer survivors: breastfriends.org.

o Susan G. Komen for the Cure, a national nonprofit based in Texas working to end breast cancer in the U.S. and throughout the world: komen.org.

o Susan G. Komen Oregon & SW Washington, local chapter of the national nonprofit: komenoregon.org.

o Breast, Cervical and Colon Health Program, Washington State Department of Health program that offers free breast, cervical, and colon cancer screening to qualifying low-income people: 888-438-2247, doh.wa.gov/YouandYourFamily/IllnessandDisease/Cancer/BreastCervicalandColonHealth.

o American Cancer Society, an Atlanta-based nonprofit with local offices in 900 cities across the country, including Portland: cancer.org.

o American Cancer Society’s Cancer Survivors Network, connect with other survivors: csn.cancer.org.

Earlier this year, a Canadian study challenging the need for annual mammograms prompted women across the country to question whether they needed the yearly X-rays.

Local radiologists — and their counterparts elsewhere in the U.S. — agreed annual mammograms are still important and remain the key detection method recommended by the American Cancer Society.

“We’ve had a lot of questions from women when they come in,” Dr. Jennifer Ochsner, a radiologist at The Vancouver Clinic’s Breast Care Center, said this spring. “Questions are great. Questions are good. Scientific articles are great, no matter the result. But in this case, I don’t think the data should change anything.”

The American Cancer Society recommends that women 40 and older should have a mammogram and clinical breast exam every year. That recommendation hasn’t changed.

The February study, published in the British Medical Journal, reported findings based on the women who took part in the Canadian National Breast Screening Study in the 1980s. The study concluded annual mammography didn’t lead to a reduction in breast cancer mortality for women 40 to 59 years old beyond that of physical breast exams alone or usual care in the community.

But experts in the field, and local radiologists, disagree with the findings and argue the initial study was flawed.

“This is the only randomized, controlled study that has not shown mortality reduction,” Ochsner said in February. “It was an outlier then. It’s not surprising that 25 years later, it’s still not showing a reduction.”

While the Canadian study didn’t find an advantage to mammography screening, numerous other studies have. Radiologists say early detection is key for improving survival rates and mammograms are instrumental in finding lumps too small to be felt during breast exams.

According to the American Cancer Society, breast cancer mortality rates in the U.S. dropped 34 percent from 1990 to 2010 — a decline attributed to early detection and treatment improvements.

“Screening mammograms continue to be an important tool in reducing breast cancer deaths,” Ochsner said.

“So in my opinion, yes, women should still get screening mammograms,” she added. “Definitely.”

Self-exams valuable

While breast self-exams are no longer considered an essential early cancer detection method, health care providers say they still have value.

The goal is to increase familiarity with the breast tissue, which will make it easier to notice abnormalities. Those abnormalities can then be reported to a health care provider for further examination and, if necessary, testing.

A study of women undergoing breast cancer surgery found that despite frequent screening mammograms, about 40 percent of breast cancers were discovered as the result of lumps or suspicious changes found during breast self-exams, according to the Mayo Clinic.

Health care providers recommend women conduct monthly exams beginning at age 20. The best time of the month to perform the exam is during the week after menstruation, when the breast tissue is softest and easiest to examine.

The self-exam has two parts: visual and physical.

Women should begin by examining their breasts in a mirror. They should inspect their breasts for bulges, dimpling in the skin and changes in skin color. They should also lift their arms above their heads and check the underside of the breasts for unusual bulges or dimpling, according to health care providers.

Women should also check their nipples for changes, such as discharge or the nipple becoming itchy or crusty, according to providers.

For the second part of the breast self-exam, women should lie on their back on a bed with a towel or small pillow under their right shoulder. With the right arm raised above the head, the woman should use the pads (not the tips) of her middle three fingers on her left hand to feel for lumps in her right breast.

Health care providers recommend women use one of two methods. One method is to use an up-and-down motion, beginning at the outside of the breast and working across the entire breast.

The other method is to use a circular motion, beginning at the outside of the breast and working toward the nipple.

While feeling for lumps, women should apply different amounts of pressure to reach different depths of breast tissue. After finishing the examination of the right breast, switch arms and check the left breast.