Caring for your health
Ko'olau Radiology, Inc
1380 Lusitana Street, Suite 200, Honolulu, HI 96813
Phone: 808-599-4471  Fax:  808-523-3849
Screening Mammography is Important!!

Recently, conflicting information has been released in regards to screening mammography and what the guidelines are.  Below you will find my recommendation and the guidelines in which Koolau Radiology, Inc follows. 

Screening mammography is the most effective thing that a woman can do to reduce her chances of dying of breast cancer. All the scientific evidence to date, including large randomized, controlled trials, has shown that screening for breast cancer saves lives.  Screening mammography has improved significantly with technology developments. Approximately 10% of screened patients will be recalled for additional studies including magnification views, angled oblique projections, or diagnostic ultrasound examination. Some will be asked to return in 6 months for a repeat exam of the area in question in order to be careful. Only 1-2% of women screened will be advised to have an imaging guided needle biopsy using local anesthesia.  20-40% of these biopsies will reveal cancer. Cancers detected in this way are typically more curable than those first detected as palpable lumps.

In the United States significant utilization of screening mammography began in the mid-1980s.  In 1990 the mortality rate from breast cancer, which had been unchanged for 50 years, began a steady decline. Today more than 30% fewer women die each year from breast cancer than would have died had the pre-1990 death rate continued. Approximately 15,000-20,000 lives are saved annually, in large part due to early detection with screening. Improved and more effective therapy including surgery, radiation and chemotherapy has also contributed to the reduction in mortality. All therapies are most effective when applied early.  In one Swedish study, published in the journal Cancer (February 15, 2013), researchers found that 30% fewer women in their 40s who were screened, died from breast cancer compared to those who were not screened, but all had the same access to treatment. In a Harvard study, it was found that 71% of the women who died from breast cancer were among the 20% of women who were not participating in screening. This relationship was particularly clear for women who were not being screened in their 40s compared with those who were being screened. Cancers that are develop in patients who are in their 40s tend to be more aggressive and rapid growing than tumors that develop in later years.
Screening based on risk, with the screening limited to only high-risk patients, is an ineffective approach to reduction of breast cancer mortality. Only 10 -25% of patients diagnosed with breast cancer each year are in the high risk category.

Women must understand that there is no biological, medical or scientific reason to delay screening until age 50.  Too many cases of unscreened, mid-40s patients present with advanced stage breast cancers. These patients could have potentially been diagnosed and treated much earlier had their screening been initiated at age 40.  Patients who have first order female relatives  (mother or sister) with pre-menopausal breast cancer are advised to begin their own screening program. This program should be initiated to coincide with 10 years prior to their relative's age at cancer detection. For example, if your mother was diagnosed with breast cancer at age 47, your screening should begin when you are 37 years old.

Ductal carcinoma in situ is an early phase in the biological development of breast cancer, before it has invaded outside the breast ducts. It is, however, unwise to assume that these early cancers will never invade. It is not possible to determine with any currently available technology when such an early cancer will become invasive. For some patients, based on their overall health status, a more conservative wait- and- watch strategy may be appropriate.

Mammography is not the ultimate solution to breast cancer. Screening doesn't find all cancers and doesn't detect all cancers early enough to result in a complete cure. Screening has been rigorously tested and proven to save thousands of women's lives each year.

Start your screening program at age 40.

Richard L DeJournett, MD