The cancer was discovered on a mammogram she had at the insistence of her infertility specialist, according to an article in Boston Globe. Unless there is a particularly high risk of breast cancer, mammograms are generally not recommended for women under the age of 40.
Globe writer Deborah Kotz wonders if Rancic’s case may encourage other young women to insist on mammograms, and if that’s a good idea. Here’s an excerpt from her article:
“While Rancic was lucky, her urging women to get screened, as she did this morning, requires some qualifications. Mammograms are known to be particularly poor imaging tools for finding tumors in young women; that’s because women in their 30s tend to have denser breast tissue that looks similar to a tumor, which is also dense. Often mammograms miss significant tumors in those under 40 and even more commonly, they find a host of abnormalities that turn out not to be cancer.
“I’m worried, though, that women may be swayed more by Rancic’s powerful story than the faceless, emotionless science.”
Ms. Kotz presents a fascinating question, so I reached out to Dr. Diane Radford, Surgical Oncologist at Mercy Clinic St. Louis Cancer & Breast Institute. She was quick to urge that women consider individual circumstances.
“As with everything, we have to make decisions based on evidence, not emotions,” Dr. Radford cautions. “We have to balance potential good versus potential harm. It’s important too, to differentiate a screening mammogram (done for an asymptomatic woman) from a diagnostic mammogram (if there are symptoms, a mass, pain, discharge etc).
“We know that the female breast is very sensitive to radiation before the age of 30; survivors of the atomic bomb blasts in Hiroshima and Nagasaki who were less than 30 at exposure, had a much higher incidence of breast cancer than expected. I recommend the American Cancer Society guidelines for breast cancer screening (for asymptomatic women).
“If a woman presents with symptoms, then appropriate imaging should be done, including mammograms, ultrasound and MRI as deemed necessary. When symptoms are present, a woman is no longer in the “screening” population. I will generally order an ultrasound for those under age 30.”
Dr. Michael Musci, medical oncologist from Ironwood Cancer & Research Centers agrees.
“It is not standard practice to screen women under 40 years of age because the sensitivity of mammograms in this age group is not optimal. Testing based on genetic risk factors or those with clinical concerns (most commonly a palpable mass or strong family history) makes sense because in a higher risk patient, testing is more likely to find breast cancer.
“Any test, even self breast exam, should be reviewed with your physician with some discussion of the limitations to avoid unnecessary surgery for benign lesions. Aggressive testing in low risk populations can increase the number of biopsies and surgeries on healthy women.”
As for Giuliana, I’m sure she’s very grateful that her breast cancer was caught on a mammogram while still in the early stages. Her high public profile means that she’s already helping to initiate conversation between women, their families, and their physicians. That’s a good thing.
From one breast cancer survivor to another, I wish you well, Giuliana. I hope you find the care and support you need and that your dreams of motherhood come true. Yours is a powerful story, and you have a lot of living left to do.
