What We Can Learn From A Man With A Mammogram
Frankly, I’d be willing to bet that if one man in nine developed breast cancer, the recommendation would be to do weekly breast self-examinations. – B. D. Colen
His article reveals quite accurately the common problems and failures experienced by women in detecting and confirming or disconfirming cancer in their breast. Most men have no idea what it is like to get a mammogram.
As a scientist whose life’s’ work was developing the standards that train fingers belonging to doctors and nurses to not miss a small (<5mm) solid breast tumor and to not confuse that feeling with normal breast tissue, B.D. Colen’s experience is most instructive.
Each year 33 million women undergo this screening process and 40 thousand will die of breast cancer.
Not deeply hidden in Cullen’s cautiously humorous account lies important, even life-saving, truths. The evidence (cited below) documents that thousands of women who report a finding a lump or lesion in their breast are sent home only to return months later with breast cancer more advanced than necessary.
Both mammograms and personal exams produce false negatives and false positives.
In either case errors and accuracy are strongly associated with the training, experience and procedures of the clinician who palpated the breast or the radiologist who viewed the mammogram. It is also the case for young women, whose breast tissue is dense, that palpation skills are the most widely effective method of early detection and that mammograms should not be performed unless rare, special circumstances warrant.
Increasingly, the body of evidence on this subject finds that “interval” breast cancers, meaning those discovered a woman after she has had a “clean” breast cancer screening, are common. The research also documents that women themselves are the likely source for early detection. This expanding body of evidence and personal experiences like those reported by B.D. Colen will eventually lead our leading health care system to help clinicians and women learn how to use the brilliant, free equipment on the distal end of their wrists.
Mark Kane Goldstein, Ph.D.
The MammaCare Foundation
Here are a few of the reports with annotated excerpts below each
A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J. Surg 2010 Dec; 200(6): 712-7. Haakinson DJ, Stucky CC, Dueck AC, Gray RJ, Wasif N, Apsey HA, Pockaj B.
“Patients presenting with palpable masses on SBE or CBE even with a normal mammogram within 1 year tended to have more aggressive tumors… resulting in more aggressive therapy.”
Breast cancer presentation and diagnostic delays in young women. Cancer. 2014 Jan 1;120(1):20-5. doi: 10.1002/cncr.28287. Nov 11. 2014 Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, Winer EP, Partridge AH.
“Most young women detect their own breast cancers…”
Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 2010Mar; 210(3): 314-8. Mathis KL, Hoskin TL, Boughey JC, Crownhart BS, Brandt KR, Vachon CM, Grant CS, Degnim AAC.
“Patients with palpable presentation were younger than those with screen-detected cancer (mean age 57 versus 62 years…).”
Discovery of breast cancers within 1 year of a normal screening mammogram: how are they found? Ann Fam Med. 2006 Nov-Dec; 4(6): 512-8. Carney PA, Steiner E, Goodrich ME, Dietrich AJ, Kasales CJ, Weiss JE, MacKenzie, T.
“Having a lump and both a personal and a family history of breast cancer was the most common reason why women initiated a health care visit.”
Does This Patient Have Breast Cancer? The Screening Clinical Breast Examination: Should It Be Done? How? Journal of the American Medical Association, 1999 Oct, 6: 283(13), 1687-9. Barton, M.B., Harris, R. & Fletcher, S.W.
“…MammaCare’s standards for teaching and practicing effective CBE emerged from an extensive series of laboratory studies measuring lump detection and breast examination skills using tactually accurate breast models embedded with small, simulated lesions.”
How best to teach women breast self-examination. A randomized controlled trial. Annals Intern Med. 1990 May 15;112(10):772-9. Fletcher SW, O’Malley MS, Earp JL, Morgan TM, Lin S, Degnan D.
“Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills. “