Early detection for breast cancer can save lives

Too many women die from breast cancer. We know that. We all know someone or know of someone who had breast cancer and did not survive. It’s tough, no matter what your age is, but it’s tougher when young women die from it.

I still remember, from early in my practice, a woman in her late 30s who died of cancer, leaving her husband with two young children, a family shattered by the woman’s death. (By the way, he eventually remarried after meeting a lovely woman whose husband had died in his 30s of a heart attack, and they have a happy blended family.)

Back to my point — breast cancer is awful. I’m impressed by how many fundraisers there are to support breast cancer research, from fun runs to charity events to outreach. And speaking of research, a recent study in the British Medical Journal pointed out one rather important — and right in our face — factor: Detection is key.

Women who miss their first breast cancer screening are 40% more likely to die from breast cancer. Are you blown away by this headline? I certainly am. Let’s tease apart this very important study because it tells me that perhaps we’re partially missing the boat when it comes to breast cancer.

First off, this is research published in the BMJ, good juried research. Next, it’s not a double-blind placebo-controlled study. You cannot do that when it comes to something like breast cancer. You can’t have a group that is told not to screen and compare them to women who screen. That would be immoral. So we have to depend on observational studies to gather our information.

As you probably know, mammograms can detect breast cancer early, often before a lump can be felt, which improves the chances of successful treatment and survival. So researchers set out to investigate whether women who did not do their first breast cancer screening when the time came were less likely to screen on a regular basis after that.

The study was in Sweden, which has one insurance company, the government, and one medical record, the government. No co-pay, no financial issues.

Side note: Wouldn’t be nice if we didn’t have to worry about medical bankruptcy? In the U.S., it’s estimated that two out of three bankruptcies are a result of medical debt. I mention this because many in this country do not get a screening because it costs money.

So back to the study. After taking into account many factors — such as whether a person went to college or trade school, whether they were middle class, rich or poor, whether they had other risk indicators — investigators found that one out of three women did not go to their first mammogram.

Do you find this rather shocking? I do. If this were in the U.S., I would assume it’s a financial thing, which of course it would be. But in Sweden, finances don’t factor in, and yet one-third still don’t start screening when it’s recommended. Hmmmm.

This group of women, let’s call them the non-screeners, were persistently less likely to screen in the future, too. Kind of makes sense to me. And when they did screen, they were more likely to have advanced breast cancer — if they got breast cancer, they were 40% more likely to die from it.

Now, some of this is a cultural issue. Right now, we are in an anti-science mode. Because of the hurricane push against science, there is a basic mistrust of recommendations for many folks.

I understand that fully. Just because I suggest to a patient to do something, that doesn’t mean they always trust my recommendation. They want to know more. That’s where doing your own research might be useful.

But how do you know if a site you happen upon has good information? If you’re science-based, then go to science-based sites with a good reputation, not a site recommended by a movie star or politician.

For other non-screeners, this is about not understanding the relevance of the test. And for still others, it’s just a case of good, plain laziness. The use of this last word is a bit harsh, but it hits the point.

My spin: If you’re a woman and it’s time for your first breast cancer screening, I recommend you go to the American Cancer Society site for great information and get screened. If you know someone who should get screened, talk to them.

Health care is a team sport — you, your provider, your family and your friends. Stay well.