Dana-Farber doctor explains change to breast cancer screening guidelines
BOSTON - When the guidelines for breast cancer screening changed last month, many American women sat up and took notice.
The U.S. Preventative Services Task Force recommended that women go back to mammograms beginning at age 40 rather than 50.
But why? And what is the latest in Breast Cancer research? WBZ TV's Paula Ebben sat down to talk with Dr. Judy Garber, an internationally recognized leader in breast cancer research and director of the Center for Cancer Genetics and Prevention at Dana-Farber Cancer Institute. She also serves as chief advisor to the Breast Cancer Research Foundation (BCRF).
"I think the most important thing is for women to have a good discussion with their doctors about what might be most appropriate for them, and many of these guidelines now really do start at 40 and not all are every year," said Dr. Judy Garber. "Some are every other year, but when to begin is an important issue."
Dr. Garber pointed out that mammograms are imperfect. "We've always known that they can miss tissue changes throughout the breast. They're very good at seeing calcifications, but calcifications can be benign mammograms. Sometimes, you need to see things with two different lenses to have an idea what the truth is. Mammograms are not a perfect test, as we all know, and for some women whose risk is higher, the addition of other technologies, like breast MRI can be important," Garber continued. "It's important for us to recognize that screening does actually lead to much improved breast cancer mortality."
And that's why MRI's can be used as a complementary technology if something is seen.
"For women at exceptionally high risk, women with genetic risk or women sometimes with a particular finding on the breast biopsy, MRI's can be part of their routine care because mammograms are just not enough," said Garber.
Garber said more younger women are seeing breast cancer diagnoses now.
"Everyone is seeing younger women, more black women at younger ages. That was a big motivator for changing these guidelines back to age 40 where they used to be," said Garber.
Another big concern is for women who have dense breasts:
"So for most women, dense breasts are a fact of life, that's not very easy to change, and they are an indication of increased breast cancer risk. The other piece of the problem is that having more dense tissue makes it harder for the mammogram to see, now newer technologies like tomosynthesis, which is really part of the standard of care throughout New England and nationally, but breast tomosynthesis can improve the sensitivity of the mammogram so you can see despite the density," said Garber.
The stubborn complexity of the disease makes investment in the kind of research funded by BCRF so crucial.
"BCRF likes to fund high-risk high-reward transformational work," said Garber. "The money raised here stays here, and fortunately they raise money elsewhere and send it to Boston because we have so many great researchers!"
As for her optimism about the future? Garber said she's most encouraged about new drugs that are making a significant difference.
"We have this great technology of antibody-directed or antibody drug conjugates. These are ways of delivering chemotherapy to the tumor using the natural intelligence of antibodies that find cancer cells," said Garber. "They can make that treatment more effective and then toxicity less and this is work that has been pioneered in the Boston area."
But as promising as this kind of cutting-edge research sounds, Garber reiterated – it is not enough.
"As excited as we are about the wonderful progress in breast cancer, we are not finished. We have more to do and I want people to feel always that we're thinking about what's the next thing that will help women with metastatic disease, women with high risk of developing disease. We really don't want our daughters to have to deal with all of this," said Garber.
Finally, Dr. Garber advised women that they should discuss all of these issues with their doctor, and ask specific questions about dense breasts and which tests are correct for each patient.
WBZ-TV is proud to be the media partner of the Breast Cancer Research Foundation.