Advice against early mammogram a big no no

The American Cancer Society (ACS) has controversially urged women to wait until the age of 45 before getting an annual mammogram. But in a region where breast cancer diagnoses are becoming common among younger women, the news has not been well received.
"My first reaction ... I'm not impressed," breast cancer survivor, Tanya Jepson told Khaleej Times on Wednesday.
After finding a lump in her breast in 2010, a follow up with her doctor confirmed it was cancer. Jepson was in her early 40s when her diagnosis was revealed.
"I was 42. Women are getting younger. Forty is the right age - that's my belief and that's what doctors say," she said.
Now in remission, Jepson is on a drive to raise awareness of the disease. One of her strongest messages to women is the importance of early detection and early screening.
"To me this news reads like 'cost over lives'. Early prevention means fewer deaths, but it also means ladies perhaps don't have to undergo mastectomies and fewer women would need chemotherapy."
Previous recommendations from the ACS stated women be screened each year from the age of 40, but it has now done a complete 180 on the decision.
The report suggests that a 'failure to show enough lives are being saved' as the reason for the change in advice. But for Dr Keya R Shivadey of Aster Plus Medical Centre in Dubai, the news has come as a shock.
"I completely disagree with the advice. From the age of 40, most ladies go through basic hormonal changes, so it makes sense for them to get checked."
Over the past few months alone, Dr Shivadey has met with 22 breast cancer survivors in the UAE, all of whom are under the age of 35.
Figures released by the Dubai Health Authority (DHA) show that the number of women being diagnosed with breast cancer in the UAE has increased by 20 per cent over the past six years.
It also revealed that many of those patients are below the age of 40.
"For me, preventive measures are always better than leaving it until too late. It makes no sense to me to advise my patients against early screening," she said.
For Specialist Breast Surgeon, Dr Houriya Kazim, the "medical jury is out on many of these issues".
"Firstly, the ACS is not a scientific body - they are following what is published in journals. Secondly, in my own practice, I decide on the age of mammographic screening based on family history, and other risk factors such as taking HRT and density of the patient's breast."
But she agrees that it should not be a "one size fits all" mentality - especially in the Middle East where patients are presenting younger, with more aggressive types of cancer.
While ACS is advising younger women to start screening later, it is also urging women over 55 to switch to getting mammograms every two years, instead of annually.
An accompanying editorial to the ACS report stated clinical trials had shown little benefit from mammograms when it comes to saving lives among younger women.
It said that regular mammography might prevent breast cancer deaths in about five of every 10,000 women in their 40s or 10 of every 10,000 women in their 50s.
But again, Dr Shivadey disagrees.
Powerful diagnostic tool
"I cannot comprehend this news. Only one in 10 mammograms report a false positive reading. This is a powerful diagnostic tool and the advantages of it far outweigh the patient's minimal exposure to radiation."
But the task force behind the guidelines says for average-risk women younger than 45, the harms of mammography screening likely outweigh the benefits.
According to the report, early detection can help improve survival, but screening all women beginning at age 40 can also lead to problems, such as false positives, biopsies, surgeries to remove masses that may not have been dangerous, and potential surgical complications.
However, the guidelines do state that 'women should still have the opportunity to begin annual screenings at 40 if they choose'.
Offering more sophisticated screening tests, including genomic risk factors would be better for younger women than expanded screening mammography, the report argued.
The new guidelines also no longer recommend breast exams, in which clinicians manually feel patients' breasts for lumps.
Advice Dr Kazim is strongly against.
"Many women are unable to calculate their risk, so having a breast exam gives the opportunity to do this for them and at the same time check them clinically."
Breast cancer is the top cancer among women worldwide. According to the International Cancer Organisation, more than 1.6million new breast cancer cases were detected worldwide in 2013.
In the Middle East, it is the most common cause of death among women aged between 40-50 years.
Like Jepson, 53-year-old Filipina, Josefina Abaya, was diagnosed with breast cancer in 2013.
"I left it too late. I ignored it, but you can't ignore it. We have to love ourselves and look after ourselves," she said.
A champion of early detection, Abaya said she too disagrees with the latest advice from ACS, and as a cancer survivor herself, she feels best placed to give advice.
"I agree with the saying 'the earlier the better', especially when it comes to cancer. For me, early detection is better than cure."
kelly@khaleejtimes.com

Josefina Abaya