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Aware of breast cancer prevention, but confused about mammograms

Why is Chicago pink?

From O’Hare to Midway, the city is in the pink this month. The airports, Buckingham Fountain, Soldier Field, the Willis Tower and other landmarks are all rosily aglow. More than 160 pink-lit buildings “light the way to find a cure” during Breast Cancer Awareness Month.

What’s behind the lights? The Lynn Sage Cancer Research Foundation. Founded in 1985, the charity, which funds breast cancer research at Northwestern Memorial Hospital, spearheaded the color campaign 11 years ago to remind women of the importance of self-exams and screenings.

Namesake Lynn Sage illustrates why women can’t wait until 50 to start checking their breasts. She died of breast cancer at age 39. —Leah A. Zeldes

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Updated: April 14, 2014 4:49PM

Breast cancer awareness? You can hardly miss it, with the Chicago skyline glowing pink, restaurants serving pink food and scores of pink-tinged fund-raisers. Yet medical controversies make it unclear just what to do with that awareness.

“The American Cancer Society continues to recommend annual mammograms for all women from age 40,” said Debbie Saslow, director of the Breast & Gynecologic Cancer section of the American Cancer Society. Some researchers say, though, that so much testing leads to overdiagnosis and unneeded treatment.

The dispute leaves women — especially those under age 50 — uncertain about when, if and how often they should have the boob-squashing test.

Mammograms are no fun. Has any woman ever endured one without wondering whether a better test might have been developed were it men having a sensitive body part mashed between two hard, square plates every year? (And why square, anyway, now that the machines don’t use X-ray film?)

Besides discomfort, there’s uneasiness. Some estimates say one woman in five will develop invasive breast cancer, so waiting for results is worrying. Next may come further anxiety and tests — ultrasounds, MRIs, biopsies, surgery — to find, perhaps, that it’s benign.

“Ninety percent of breast biopsies are negative,” said Saslow.

Debate also touches on which abnormalities actually constitute “cancer,” and whether every cancer found early warrants aggressive treatment.

“One of the complications is that the definition of ‘early’ has changed,” said Dr. Seema A. Khan, a surgical oncologist at Northwestern Memorial Hospital and associate professor of surgery at Northwestern University.

Last November, a study showed screening led to early cancer diagnoses for 1.5 million women, while 1.4 million weren’t diagnosed until advanced stages. Therefore, argued co-author Dr. H. Gilbert Welch in a New York Times op-ed, most women, cancerous or not, endure mammography to no purpose. Women may as well wait till they find a lump, he implied.

However, research published last month concluded, “Most deaths from breast cancer occur in unscreened women.” Seventy-one percent of women who died hadn’t had annual mammograms, Harvard University authors Matthew L. Webb, Dr. Blake Cady, et. al, found. Half the dead were under 50. So guidelines calling screening optional for women in their 40s, as put forward in 2009 by the U.S. Preventive Services Task Force, or saying every two years is enough, like the Centers for Disease Control’s, may be dangerous.

Lauren Goldberg of Lincoln Park thinks so. She had mammograms from age 42, but without high risk factors, she didn’t worry when she had to skip a couple of years. Then, at 49, she noticed an odd discharge.

“My breast surgeon told me my tumor had been growing for four years,” she said.

Everyone agrees mammography is imperfect. “The more aggressive a cancer is, the less effective screening is,” said LeFevre.

Young women’s dense breast tissue both hides and encourages deadly, fast-growing tumors, Khan explained.

Yet the idea that breast cancer is a disease of the post-menopausal is so widespread that when cancer survivor Tracy Sills, then 37, found a lump, her doctor’s office told her, “Oh, you’re too young.” She had to insist to get a mammogram.

The Villa Park resident is teaching her teenage daughter about self exams, and expects her to start mammograms in her 20s. “I truly do not believe there’s a one-size-fits-all in this stuff,” she said.

“Only one out of 1,000 women will avoid a breast-cancer death because she started screening at age 40,” said Dr. Michael LeFevre, ‎professor of Family and Community Medicine at the University of Missouri and vice-chairman of the U.S. Preventive Services Task Force. That adds up to about 100,000 lives, based on population figures.

Screening’s not only about saving lives, cancer survivors say, it’s also about saving breasts. How many women have avoided disfiguring major surgery because of early detection?

“There’s no good data on that,” said LeFevre.

Goldberg’s now cancer-free, but her treatment had costs: “My breasts have been removed. I have lymphedema. I have neuropathy.... I don’t have full use of my arm from surgery.” Had screening caught her cancer sooner, she believes, treatment could have been less debilitating.

Despite pink promotions, women aren’t getting a straight message about mammograms, said Sills, now a radiation oncology analyst. “Some people, they have one at 40 and they figure that’s it.”

Leah A. Zeldes is a local freelance writer.

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