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Elisa Port

Ensuring adherence to mammo screening exams

From the July 2018 issue of DOTmed HealthCare Business News magazine

By Dr. Elisa Port

At the recent American Society of Breast Surgeons annual meeting, I presented a study demonstrating that women with breast cancer who underwent more recent mammographic screening were diagnosed with earlier stage disease and treated with significantly less aggressive therapies than those who delayed or never underwent screening. The research, conducted at Dubin Breast Center at Mount Sinai Hospital, involved more than 1,000 breast cancer patients and found that those who had a mammogram within 24 months of diagnosis had smaller tumors and were less likely to have been treated with mastectomy, chemotherapy and axillary node dissection than those who did not.

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When stratified by age, patients 40 to 49 years old who never had a mammogram presented with later stage disease and required more involved treatments. Yet, under current American Cancer Society and U.S. Preventive Services Task Force guidelines, mammography is now classified as optional for segments of this age group.

This study commanded particular attention at the meeting of the leading medical society focused exclusively on the surgical treatment of breast disease, because most research on benefits of mammograms examines the relationship of mammography to breast cancer mortality – not to the subsequent treatment regimens involved. More extensive treatment is not only difficult for patients but also for the medical system, because it involves significantly more healthcare costs and resources. Therefore, the findings should be of particular interest to healthcare system executives.

In my practice, I frequently witness the implications of this study in real life. For example, several years ago, a 45-year-old female with no family history of breast cancer came in for a consultation after her yearly mammogram showed a small breast mass. On biopsy, it proved to be cancer. When examining her, I could not feel the lump (not surprising, given that it was so small) and the lymph nodes in her armpit felt normal, with no obvious indication of cancer spread.

On that very same day, a second woman of a similar age also came in with a newly diagnosed breast cancer. She had never had a mammogram or ultrasound exam. The cancer was diagnosed after she felt a lump in her breast and noticed some nipple inversion. Her primary care doctor ordered a mammogram, sonogram, and biopsy, which ultimately led to her diagnosis. Examining her, I found that the lump was approximately 2 to 3 centimeters (over 1 inch) and seemed to be pulling on the nipple, leading to inversion. A lymph node under her arm felt enlarged. I was concerned that the cancer had taken the first step to spread.
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