The Annals of Internal Medicine, on November 17, 2009 disclosed the new recommendations regarding breast cancer screening as described by the Centers for Disease Control (CDC) and Preventive Services Task Force. The recommendations are listed below. The rating to the right refers to strength of recommendation. Rating is from A-D and I. A= highest recommendation – there’s a high certainty the benefits are substantial; D = lowest recommendation; I = insufficient or conflicting evidence.
- No routine screening mammography in women from 40 to 49 years old. Individual risk factors must be taken into account. (C recommendation)
- Biennial screening mammography for women aged 50 to 74 years. (B recommendation)
- No recommendations for women 75 years or older. (I recommendation)
- Breast self-examination (BSE) is unnecessary. (D recommendation)
- Clinical breast examination (CBE) is unnecessary in women 40 years or older. (I recommendation)
- Digital mammography and magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer are unwarranted. (I recommendation)
These new recommendations were based on numbers. The number that was prevalent in decision time was the “fact” that women younger than 50 account for less than 3% of all breast cancers which renders mammography not cost effective as a screening tool.
The main rumble in this discussion is that it erupted from a number/cost effectiveness perspective only, yet it has spurred many emotional discussions. To me, as a woman’s health advocate, I am inspired by the discussion as it brings tremendous awareness to the difference between what we do by rote, and what we do by choice. It’s one thing that guidelines have recommended women from the age 40 and over to automatically receive mammograms yearly. It’s another to understand recommendations and be able to (1) have an intimate and necessary dialogue with your physician regarding breast awareness, and not JUST from a fear perspective and, (2) have a relationship with your imaging center where you are treated like as an individual with individual needs and concerns in such a way that you are seen by a physician, not just a technician, and before you leave, you have the option to do further testing if necessary which removes the waiting game. The focus of decision making should rest in the hands of physician and patient. Medicine has separated the two.
How can women know what is best for them when the American Cancer Society and the National Cancer Institute have two different responses to the same subject? The former stands strong in recommending yearly mammograms starting at the age of 40, and the latter is reconsidering the recommendations based on the new studies. How about another controversial recommendation? The World Health Organization recommends beginning mammogram at 50, every two years. The detection rates of the European countries that follow these guidelines are similar to the United States.
Our individual decisions regarding testing rests in our own hands and this controversy has opened the door up again to regaining our involvement in our healthcare. Some unbiased researchers believe there is unnecessary risk in biopsies, repeat x-ray exposure and the fear elements that accompany this. Others believe this is a reflection of the health care reform movement to save health care spending. I personally don’t buy into the latter, although I should since I know that insurance companies make more money on us when we are sick, oddly enough.
This is about awareness. Here are my views on each of the recommendations, which haven’t even touched upon ultrasounds as an option for screening:
- Yearly screening digital mammography or automated ultrasound (based on breast tissue density) in women aged 40 to 49 years to be scheduled only after:
- Yearly screening mammography for women aged 50 to 74 years with the above subcategories.
- Yearly screening mammography for women 75 years or older who will, if a malignancy is detected be proactive in their healing.
- Breast self-massage done daily (see end of article for more details)
- Clinical breast examination yearly starting with the first pap smear or earlier if self breast healh is questionable.
- Digital mammography always in place of regular mammography. Magnetic resonance imaging (MRI) in cancer survivors if warranted.
a. Intimate, active, involved discussion with prescribing physician allowing the final decision to arise from love (of self) rather than fear (of self).
b. Intimate, active, involved discussion and experience with imaging center. This is the defining difference between going to a center created by women for women like Arizona Breastnet – the place I would want all of my patients to patron.
Women, become as active in your healthcare as you possibly can. Love your body as much as you can. I know the statistics are high of breast cancer, but that can change. The change begins with women loving their bodies, desiring and accepting love and intimacy, supporting post menopausal hormones especially with bioidentical progesterone and performing daily breast massage.
Standard recommendations have been to perform monthly self-breast exams to see if there are any lumps or bumps that need medical attention. Women typically aren’t confident with their assessment of her their own breasts … and with good reason – fear is brought into prevention! Instead, I ask my patients to enhance their breast awareness through massaging breasts daily for several reasons.
Massaging breasts daily lets you know what your breasts feel like. This enhances your sensitivity to your breasts so that if the tissue were to change you would know right away. This creates health awareness rather than disease awareness.
Massaging breasts daily flushes the lymphatic tissue of the breast which carries waste away from tissues, enhancing circulation it order to be eliminated. Lymphatic tissue elsewhere in the body parallels our muscles. Therefore, anytime we use our arms or legs, our lymphatic tissue is being pumped which circulates and eliminates waste. Our breast tissue is normally snuggly tucked into a bra and immobilized. Where does the waste go that is in this lymph of the breast tissue? Nowhere. It sits there. This is one reason we see lumps and bumps in many female patients. So massage brings loving awareness towards self and also helps keep abnormal waste from building up into abnormal cells.
To go one step further, I recommend a specific oil that is considered a lymphagogue. This means that it stimulates lymphatic drainage. Using phytolacca oil (poke root) as the massage agent maximizes your efforts for optimal breast health. Another oil that is very beneficial is castor oil.
So, I encourage every woman to massage her breasts daily for five minutes with phytolacca or poke oil. This can be done in the shower or lying in bed. Five minutes sounds like nothing. However, when you start, five minutes seems like it will never end. You will begin to think that you’ll never have to work out your arms in the gym again! There is no specific pattern of massage, just move the breasts and enjoy!