Decisions about breast cancer screening just got tougher for women in their forties. On Monday, the U.S. Preventive Services Taskforce (USPSTF), a government-sponsored panel of clinicians and preventive medicine experts, released new guidelines that for the first time recommend against annual mammography for "normal risk" women in that age group.

Instead, it recommends they have the test every two years. Sounds pretty straightforward, right? The problem is that the recommendation conflicts with those of almost every other major U.S. health organization. They include the the American Cancer Society, which is strongly critical of the USPSTF. Why the disagreement?

When a woman is diagnosed with breast cancer, a mastectomy is not the overwhelming first choice of treatment, according to a survey October 14 issue of the Journal of the American Medical Association.

Researchers developed the survey to determine if the perception that women are being overprescribed mastectomies is true. Turn outs, it really isn't. Instead, about 75 percent of the nearly 2,000 women polled initially opted for breast-conserving treatments, like lumpectomy. (Some patients with later stage cancer did end up having a mastectomy after the first treatment was not successful.)

Though only 20 percent of patients sought a second opinion, the research shows that the recommended treatment didn't tend to change after another opinion.

Learn more about breast cancer:

• Real Woman's Guide to Breast Cancer
• The 4 Best Ways to Protect Yourself from Breast Cancer
• Does Breast Cancer Run in Your Family?
• Can You Protect Your Daughter from Breast Cancer?

Catching a pass is important in football, but catching breast cancer in its early stages can be a lifesaver. Tanya Snyder, a breast cancer survivor and the wife of Redskins owner Dan Snyder, talked to the TODAY show about pro football's commitment to take on a fierce opponent.

• Check out some of the players involved with "A Crucial Catch"--the NFL's campaign to promote breast cancer screening
• Find out how to lower your risk of breast cancer
• Get more information, news, and tips about breast cancer

For many women, the old adage "better safe than sorry" has a lot of weight when deciding whether to be screened for breast cancer. However, a recent study out of Denmark says that one in three breast cancers detected by a screening mammogram may be treated unnecessarily - and cause unnecessary trauma.

 

The study, conducted by Karsten Jorgensen and Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen, confirms that more cases of breast cancer are discovered once screening programs began. In theory, a successful screening program results in a drop in cancer detection in older women, since these cases would be caught at a screening at an earlier age. Instead, the study found that the number of cases in women aged between 50 and 69 simply grew to thousands more than were identified earlier.

 

Some cancers grow too slowly to affect a patient, but it's impossible to distinguish between these slow-moving cancers and those that are deadly. For this reason, any cancer found is treated.

 

The final diagnosis? Jorgensen and Gotzsche say there are negative consequences in treating women for breast cancer unnecessarily, including psychological damage and harmful side effects.

 

But don't write off the importance of mammograms, other experts say.  Dr. Richard J. Bleicher, a breast cancer surgeon with Fox Chase Cancer Center in Philadelphia, reminds women that screenings do increase the survival rate, and that the overall survival rate has increased.

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A front page story in today's New York Times blurted out: "Study of Diseases and Genes at an Impasse!" The article reflected on commentaries from the New England Journal of Medicine discussing whether genetic risk prediction is really worth pursuing for the majority of common diseases. This is a good question not only because companies are offering tests of genetic risk to the public, but also because this line of research is very expensive and may not be worth it. Over the past decade the dogma has been that our genes could be used to figure out what diseases are in our future and maybe even to design drugs to prevent them. This dream may well be just that...a dream. It seems that while some genetic variations -- such as the breast cancer genes BRCA 1 and 2 -- are responsible for a very high risk of subsequent disease in an affected individual, the number of such individuals is low. In the case of the BRCA 1 and 2 genes, they correspond to only 5-10% of all breast cancers. On the other hand, there are many genetic variations that may be responsible for a very small increase in risk for breast cancer, probably not enough to even note. Even combinations of these many variants are probably not yet reliable predictors.

What does this mean to science and to us?
For science it means we need to reevaluate this approach as the "holy grail." Maybe figuring out the genes isn't as important as figuring out the causes or conditions that lead to the diseases. A child could have the genes for Type 2 diabetes, but be raised in poverty without enough to eat and never experience it. The DNA doesn't change, but the way it plays out may be very different in a different setting. As such, it may well be easier to change the environment than the genes! For us, personally, this debate means that we need to be careful of commercial companies and doctors that propose to analyze our genes and tell us what diseases are in our futures. To quote Dr. David B. Goldstein, a Duke University geneticist, "With only a few exceptions, what the genomics companies are doing right now is recreational genomics." The risk estimates from this analysis are unstable and may actually be significantly higher or lower than reported as more research is done.

The picture may well be different in five years, but for now you probably should just ask your grandmother what diseases run in the family and live as healthy a lifestyle as you can.

Susan Love, M.D., one of the "founding mothers" of the breast cancer advocacy movement, continues her work by serving on the boards of the National Breast Cancer Coalition and the Dr. Susan Love Research Foundation. Read more on Susan's blog

It seems that everywhere I look doctors and journalists are talking about how we don't get enough vitamin D. In the breast cancer world, this belief started with studies that showed that women who live closer to the Equator experience less breast cancer. The assumption was made that the reduction in breast cancer rates was linked to the sun and vitamin D.

Even though other studies have been equivocal, everyone is still climbing on the vitamin D bandwagon. A study released last week suggests the issue is more complicated than we would like to believe. In this case, researchers found that giving vitamin D supplements to women with breast cancer did not raise their blood levels of the key breakdown product. Does that mean they should take more? Let's not forget: Too much vitamin D can be dangerous!

The whole controversy reminds me of the beta carotene story. It was first observed that people who ate a lot of carrots had a lower rate of lung cancer. The conclusion was made that it must be the beta carotene, which is a key part of a carrot. When researchers performed a study randomly assigning smokers to take beta carotene supplements versus placebo, they anticipated that there would be less lung cancer in the beta carotene group. Much to everyone's surprise, there were more lung cancers in the beta carotene group.

This was a reminder then -- and still now -- that we have to be careful about getting carried away on what the key component is of any new miracle finding. In the case of the reduced breast cancer rates for women near the Equator, maybe there's something else about being in tropical climes that is important to preventing breast cancer -- and not just vitamin D and sunshine. I don't know the answer, but moving to Tahiti might not be a bad way to find out!

Susan Love, M.D., one of the "founding mothers" of the breast cancer advocacy movement, continues her work by serving on the boards of the National Breast Cancer Coalition and the Dr. Susan Love Research Foundation.