Breast cancer is a very serious public health problem. It is the second leading cause of cancer deaths in women, and its political and socioeconomic implications are enormous! The incidence of breast cancer has more than doubled in the past 30 years: In 1964, the lifetime risk was 1 in 20; today, it is 1 in 8. More than 180,000 women in the United States are diagnosed with breast cancer each year. Breast cancer is not only one of the leading causes of death in women in general, but also the leading cause of death in American women ages 40-55.
The leading risk factor for developing breast cancer is simply being female; the next most important risk factor is age. Breast cancer risk increases directly with age. The American Cancer Society recommends that women ages 20 and older perform monthly breast self-examinations and receive a physical examination every three years, and that women age 40 and older receive an annual mammogram and physical examination. Mammography is still touted as the single most effective method of screening, but it fails to detect as many as 20 percent of breast cancer cases in women over age 50, and as many as 50 percent in younger women.
There have been many papers published in the past 12 years concerning breast MRI, and virtually all of them indicate that MRI is a technique with incredibly high sensitivity for the detection of breast cancer. It has a specificity far better than conventional mammography, and yet few professionals are doing it. For some reason, it has not gained any popularity in the medical community at large.
Why is breast MRI not readily available? Reasons include cost; difficulty understanding this imaging modality; time required to train a professional to use the modality; and the medical community itself. This last reason is most disturbing. Many radiologists and mammographers have spent enormous amounts of money and time trying to convince the government and the public of the value of X-ray mammography. To "shift gears" now would be difficult - even embarrassing. In short, it is a very touchy subject.
The purpose of this article is to inform and allow readers to develop their own opinions. So, here are some interesting facts:
To date, there is only one reliable screening procedure: the BSE. Early detection is paramount in saving lives. Mammography is not a reliable screening modality. Now, here's the rub: MRI is too expensive presently to use as a screening modality, and not easily available to the general population. We are left with BSE, and clinicians who still send women out for mammograms when women find something on their own BSEs. This is not good medical practice. Both the clinician and the patient are uninformed or just ignoring the facts. This disease process is increasing in over half the population, with no cost-effective means of screening for the disease - with the exception of self-examination. Moreover, the majority of clinicians and the population still rely on a modality that is not reliable. I remind you of the old adage, "Let the buyer be ware." Or is it, more appropriately, "What you don't know can hurt you"? Everyone needs to take responsibility for his or her own health and stay informed.
Deborah Pate, DC, DACBR
San Diego, California
patedacbr@cox.net
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