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should you be getting screened for breast cancer?

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I remember those five minutes so clearly. I was in a change room trying on bikinis, as a university student on spring break would. As I adjusted myself into the bandeau top, I felt something: a very noticeable lump in my right breast. Immediately my eyes welled up and I stared into the mirror, thinking of my grandmother who died from breast cancer five years earlier. I had to pull myself together as my friends asked me to show off the bikini. I told them that none of the suits fit me properly.

At 22, I was too young for a mammogram. So I had an ultrasound and a biopsy (a needle injected into the lump to extract cells for analysis) that revealed a benign cyst. Even though I trusted my doctors and the test results, I opted for surgery to remove it.

We put so much trust in the tests and results we’re given. So when new research finds fault with their methods, it can be concerning. The New York Times recently questioned the accuracy of some breast cancer biopsies, and the are-they-or-aren’t-they-necessary argument surrounding mammograms rages on. Now that I’m 40 (the age to start getting mammograms, or at least it used to be), I want to make sense of it all. So I spoke with Martin Yaffe, PhD, a breast cancer researcher with a specialty in imaging at Sunnybrook Health Sciences Centre in Toronto, and Dr. Alexandra Ginty, a family physician in Oakville, Ont., who is Ontario’s regional primary care lead for cancer care in Mississauga/Halton and a blogger at facingcancer.ca. Yaffe says that medical testing is improving, and many of the methods critiqued in long-term studies have been enhanced. As well, while biopsy results can vary slightly depending on the pathologist who reads them, Ginty explains that unusual results are often reviewed multiple times, leaving less room for error.

Mammograms have been shown to be the best way to detect breast cancer early in average risk women, says Yaffe. Up until a few years ago, women over 40 were screened every year. That has changed to between ages 50 and 74 and every two to three years, depending on the risk factors. But Yaffe thinks women should consider asking their doctors for mammograms starting at 40 because it could save more lives. “If a woman happens to find cancer herself early, she may do fine,” he says. “But there’s no guarantee, and in many cases you don’t find the cancer yourself until it has become fairly advanced.”

Ginty says premenopausal women (aged 40 to 50) generally experience more aggressive breast cancers that can be found through a physical exam or ultrasound. “When you’re younger, it’s harder for the mammogram to detect [signs of cancer] because breasts tend to be denser,” she says. Mammograms may detect cancer earlier, adds Ginty, but the benefits may not outweigh the risks for women in the low-risk category. Then there’s the self-exam. Remember the daisy wheel method? Ginty says it’s no longer used because it caused unnecessary anxiety, since breasts feel different day to day because of hormones. “Become familiar with your breasts and look for differences and skin changes,” she advises. “‘Touch, Look and Compare’ is what doctors suggest now.”

The good news: The Canadian Breast Cancer Foundation reports that the five-year survival rate for breast cancer in women is 88 per cent, and mortality rates have decreased by 43 per cent since their peak in 1986. That’s likely thanks to earlier detection and better understanding of risk factors like lifestyle and the BRCA 1 and 2 genes. Ginty and Yaffe advise asking your doctor about getting screened if you’re at high risk.
Knowing now that my grandmother’s cancer was not considered hereditary, I’m still happy I pushed to get my lump removed. Even today, I feel we have to be our own health advocates.

BE TESTY

If you are between 50 and 74 years of age, you can get a mammogram without a doctor’s referral. In Atlantic Canada, be on the lookout for the Pink Tour cruiser, and in British Columbia, keep your eye out for the mobile mammography vans. Both are sponsored by the Shoppers Drug Mart WOMEN program, which aims to improve the health of women across Canada. For more info, go to shoppersdrugmart.ca/women.


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