October marks Breast Cancer Awareness Month, dedicated to raising national consciousness about the more than 200,000 women who are diagnosed with the disease every year. But this year, the month has been accompanied by some controversy over the research in the field regarding the most common cancer diagnosed in U.S. women.
How often should women get screened?
New breast cancer screening guidelines released this month from the American Cancer Society (ACS) call on younger women with no family history of breast cancer to scale back on how many times they get checked for potential tumor. The recent news has sparked a fierce debate over what’s being called a major shift in thinking about breast cancer.
Previous guidelines recommended that women undergo a mammogram every two years starting as early as 35. The new ACS guidelines differ, asking women to start screening at 45 instead of 40 and transition to screening every two years at the age of 55. ACS also recommended that doctors stop screening women with a life expectancy of less than 10 years, arguing they will die with the cancer, not from it. The new recommendations also do away with the six-minute clinical breast exam during which a doctor feels around for lumps.
Dr. Marlene Meyers, assistant professor of medicine and director of the survivorship program at New York University Perlmutter Cancer Center, said the guidelines show some evolution in the conventional wisdom about breast cancer.
These guidelines are based on not wanting to hurt anyone with more screening.
“These guidelines are based on not wanting to hurt anyone with more screening. We need more benefits than risk,” Meyers told ThinkProgress. “Oftentimes, you would have to screen many women to find one breast cancer. The problem is when you do that, you find more false positives which leads to more follow-up screenings and no improvement in chances of survival.”
On average, 10 percent of women will be called back for further testing after their screening examination. Often time, only half of them have signs of breast cancer, according to data collected by the National Cancer Institute. In the last ten years, nearly half of women screened for breast cancer have had false positives. Of that group, 7 to 17 percent went through with biopsies — a procedure during which a sample of tissue is taken from the body. Additionally, up toward 46 percent of women with invasive cancer will have negative mammograms, especially if they’re young and have dense breasts.
Such situations often delay cancer diagnosis, shaving off time needed to stop it from metastasizing. False positives also exacerbate worry and fear, especially since the tumor detected would go away on its own or remain a size that wouldn’t harm the woman.
But many young women remain skeptical about prolonging screening, arguing that it’s better to be safe than sorry in preventing breast cancer. Some cancer survivors are also pushing back, saying that early screenings saved their lives.
For instance, Rep. Debbie Wasserman Shultz (D-FL), a breast cancer survivor, recently called for a moratorium on research until researchers build consensus on the guidelines. Jennifer Johnson, senior director of mission marketing and communications at Young Survival Coalition, a breast cancer awareness organization, also questioned the new recommendations, pointing out high instances of breast cancer diagnoses among black women in their late-20s — well before the age the ACA guidelines recommend for the first mammogram.
Meyers told ThinkProgress that more prospective studies — a type of research that follows a group of similar individuals over a long period of time — could help answer questions about what type of screening practices are most effective.
Carrying out that type of experiment, however, often proves difficult because of doctors and patients on both sides of the debate feel very passionate about their position on the matter. When that dedication to perspective isn’t taken into account, test results could become biased. “It would require screening many women over a year. If we’re looking the risk of developing breast cancer, we would have to follow then for ten or more years,” Meyers said.
Is there any way to prevent breast cancer?
Research in recent years has brought forth discoveries into the causes of breast cancer, with a particular focus being on the effects of exercise, weight gain, and diet. Scientists have also explored what role common gene variations play in cancer risk.
Out of these discoveries came new methods of treatment and prevention. The most notable is chemoprevention, in which fenretinide — a vitamin A-related drug — reduces the risk of breast cancer, as shown in a small study. Scientists are also mulling over the use of aromatase inhibitors, which are substances that stop the production of estrogen in postmenopausal women, to reduce breast cancer. Another option that has sparked much discussion involves the use of osteoporosis medication, particularly when it comes to resurgence of malignant tumors. Researchers have also explored acupressure — the application of pressure to points of the body — as a tool in reducing breast cancer-related fatigue and pain.
Even with all of the research, an ongoing quandary about breast cancer centers of the biology of the tumor. The next step for researchers, Meyers says, will be deciphering different types of tumors and zeroing in on those differences to create treatment better tailored to patients.
Another point of contention centers on the impact of diet and exercise on the development of cancer. A recent study found that fewer than 20 percent of cancers are unpreventable, suggesting that developing the disease is simply a matter of bad genes and bad luck. But critics said the framing of that study could discourage people from taking their health into their own hands.
Does awareness make a real difference?
Breast cancer philanthropy efforts have faced similar scrutiny in recent years, due to what’s known “pinkwashing” — the rebranding of corporate products that have been found to contain cancer-causing ingredients. During October, everything from car dealerships to NFL uniforms turns pink.
But how effective are these efforts to raise awareness? Some advocates think they don’t work at all, pointing to studies that have found that pink branding may actually lead Americans to take breast cancer less seriously. Pinkwashing critics have recently raised awareness about what they describe as deceptive marketing tactics, compelling members of the public to inquire about the percentage of donations that go to breast cancer research and the organizations that receive the funds.
Last year, Breast Cancer Action, a national grassroots breast cancer awareness organization, took things a step further, launching a campaign to stop “pinkwashing.” In her statement on Breast Cancer Action’s website, Executive Director Kuruna Jaggar appealed to environmentalists and health activists to rally against producers of Swiffer products and Cover Girl cosmetics — products that contain cancer-causing chemicals — for their attempts to profit from breast cancer awareness campaigns and cover up their part in perpetuating the prevalence of the ailment.
In some cases, awareness may be leading women to take what some may consider extreme measures to mitigate their risk of breast cancer.
For instance, after award-winning actress and philanthropist Angelina Jolie underwent a double mastectomy — during which doctors remove both breasts — after discovering she had the gene for breast cancer, her prominent act of raising awareness about the surgery prompted what researchers called the “Angelina Jolie Effect.” A Canadian study last year showed that referrals to a genetic counseling facility doubled after Jolie announced her decision, especially among women with a genetic history of breast cancer. It represents an uptick in mastectomies that has taken place since the late-1990s, when the rates at which women underwent the procedure increased by double-digit points.
Even with a 95-percent reduction rate among women who receive mastectomies, the risk of breast cancer still exists, due in part to the probable presence of cancerous breast tissue in armpits, the abdomen, and above the collarbone. Studies — including one that followed nearly 190,000 women in California — have also found that removal of both breasts didn’t extend patients’ lives any more than the removing cancerous lumps, followed by radiotherapy. Many experts warn against taking what they consider a drastic measure to prevent the spread of a tumor.
A mastectomy is a major procedure that can require significant recovery time and may entail breast reconstruction.
“A mastectomy is a major procedure that can require significant recovery time and may entail breast reconstruction, whereas a lumpectomy is much less invasive, with a shorter recovery period,” Stanford University’s Dr. Allison Kurian told the Guardian after the release of the study.
While Meyers wasn’t so quick to call the decision to get a mastectomy reckless, she did advise patients to talk with doctors and seek other opinions before doing it. “There are definitely many women who do this out of fear rather than information,” Meyers told ThinkProgress. “That’s why doctors need to have that personal discussion with their patients.”