The New York Times has an excellent series of articles, called “Forty Years’ War”, reviewing medicine’s efforts to fight cancer over the last forty years. This weekend’s article reviews the important issue of prevention of breast and prostate cancer. For both diseases, there are well documented studies that show a decrease in new cases of those cancers with specific medicines taken over many years. And yet, many years after these were well published all over the world, there are very few doctors changing their practice and prescribing these. The main reason is that both studies were not powered to show survival improvements. That means that doctors still have no survival data to help patients decide whether the risks outweigh benefits. It’s a fascinating tale.
What Is Your Breast Cancer Risk?
A more relevant question for women would be: am I at high risk? Women can do a simple online risk calculator; if their lifetime risk is >20%, then they may want to discuss preventive medicine treatments with their doctor or a specialist. Fortunately, Beijing’s community is now fortunate to have access to a new cancer center at BJU, the New Hope Oncology Program, run by Dr Philip Brooks. They are currently running a United PINK Campaign to raise awareness about breast cancer.
What Else For Prevention?
There are very few women in such an obvious high-risk group; what else can women do to be more proactive in cutting their risk? Again, there’s an excellent review article from the New York Times which can help women take more control of their futures. This 2008 article is a subset of their outstanding collection of wellness articles.
Mammograms After 40, or 50?
Some of you may have just read the news that a U.S. task force has just revised their mammogram recommendations, now saying that women should start screening after 50 and not 40. Also, they should screen every two years and not annually; and they no longer recommend self-examinations as useful. Needless to say, this is a controversial change of policy. But it is true that they did review the latest data and concluded that the 40-50 year age group was not getting any survival benefit from annual screening, and the risks of false positives and their follow-up procedures were doing more harm than good. And many agencies do agree with the guidelines, which are more in line with existing European guidelines.
No matter what, if a woman is concerned, she should discuss her screening options with her doctor. And if she wants a mammogram between 40-50 years just for peace of mind, she should be allowed to get it — as long as she understands its limitations.