Breast surgeon Donald Keenan at The Western Pennsylvania Hospital emphasizes the importance of mammograms, even in light of the Oct. 21 Journal of the American Medical Association article challenging the beliefs that breast cancer screening is responsible for reduced death rates.
"It's good that the information is out there, but [like any piece of information], it has to be interpreted," he said.
"The benefits of mammograms may have been slightly overstated. They don't necessarily help everybody." But that form of screening will transition to something else, he predicted.
He cited the progress that's already been made in treating breast cancer, arising from work done by the city's medical community.
"Norman Wolmark and Tom Julian are world-renowned names outside of Allegheny County," he said. Dr. Wolmark is chairman and principal investigator of the National Surgical Adjuvant Breast and Bowel Project, the research consortium based at Allegheny General Hospital and mostly funded by the National Cancer Institute. Dr. Julian, surgeon, researcher and educator, is associate director of the Allegheny Breast Center. He has also been a principal investigator for many breast cancer clinical trials.
Dr. Keenan cited the groundbreaking work done in Pittsburgh to confirm that for many women a lumpectomy with or without radiation gives the same results as a mastectomy. That research was led by Bernard Fisher, longtime University of Pittsburgh professor of surgery and co-founder of the Breast and Bowel Project, which he chaired in the years 1967-94.
Before recently joining West Penn, Dr. Keenan was co-director of the high-risk breast cancer clinic at the UPMC Hillman Cancer Center and a surgeon in the Magee-University of Pittsburgh Cancer Institute Breast Cancer Program.
He said a new method of screening for breast cancer, digital mammograms, has its limitations. "No question, for certain women, with very dense breast tissue, they find things film mammograms won't," he said. He did not want to argue about the cost-effectiveness of the more expensive digital method, he said, but he did point out that not every hospital can afford the equipment, and that the prevailing concern he has is that women get a mammogram of some kind.
"Its benefits may have been overstated," he said, "but it clearly helps a certain percentage of women." He recommends the annual mammogram starting at age 40 or, if it applies, a screening for a woman 10 years before she reaches the age a first-degree family member was diagnosed with cancer.
"I firmly believe the benefit of mammograms is overstated, but I firmly believe that people who get mammograms will have lower [death rates]. There is no way there is enough data to switch our recommendations."
Dr. Nancy E. Davidson, director of the University of Pittsburgh Cancer Institute, said the JAMA article is "a thought piece to think about where our accomplishments are leading us." Women should not take the criticism of overdiagnosis as an excuse not to get a mammogram, she said.
She said screenings are part of a medical team's information.
"The central portion of every medical team is the patient. In over 20-plus years of practice, the huge message is that women are empowered to be an essential part of the team. Women do have many medical choices, thanks to clinical trials. They decide what are the pros and cons."
She said there's improved early detection in various forms of imaging, and there's been progress in finding new therapies, both in understanding cancer's pathways, for example, and in treatments.
Aggressive cancers are a challenge: "We try to find out what makes them tick."
"Sometimes you can do all the right things, be religious about your tests, get your mammogram, but sometimes can't be cured. Women who have mammograms still have the best chances."
Jill Daly can be reached at firstname.lastname@example.org or 412-263-1596.