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Mammography

According to retrospective studies of three nationwide cohorts in Europe, young women with BRCA1 and BRCA2 are at greater risk from diagnostic radiation. Any exposure before the age of 30, increased breast cancer risk 90%. In another study reported in BMJ, any mammography before the age of 30 raised the risk by 43% (question of statistical significance?) The American Cancer Society recommends MRI screening for BRCA mutation carriers. No mention was made of physician breast examination.

Mammography suffers in silence from a lack of sensitivity. Women are given to believe that mammography will protect them whereas it occasionally misses the diagnosis of a palpable lesion. In my practice, it angered me to find four patients with negative mammograms who came to me with palpable lesions much further advanced than they might have been but for a simple breast examination. Admittedly, four in my practice was probably a skewed series. The women involved, however, would not think so.

Sadly, today women are reluctant to remove their clothing for examination and providers are all to happy to forgo the challenge out of expediency and for the sake of time. It comes to a sad state of affairs when providers and patients look to a machine for a diagnosis --- to say nothing of the widespread abusive application of CT scans.
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Flora E. van Leeuwen, PhD, Netherlands Cancer Institute and reviewed by Dori F. Zaleznik, M.D.; Assoc. Clin. Professor of Medicine, Harvard Med Sch.

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