Why John West M.D. is Passionate about Starting Mammography at "40not50"
BreastCareNetwork interviewed Breastlink founder Dr. John West about controversial breast screening guidelines and his ambitious new book aimed at providing all women with clear, straightforward advice on breast cancer screening.
John West MD:
My book is Prevent Survive Thrive - Every Woman's Guide to Optimal Breast Care.
We're making so much progress in breast care, catching it early, saving lives, and yet women are not taking advantage. The problem is their primary care doctor should be telling them what is optimal breast care. But things have gotten so complicated in our field of work and primary care physicians are so busy on the computer and doing a million other things they don't have time to discuss controversies or go into issues like when to start a mammogram; what's the significance of breast density; who needs high risk testing. All these issues are critically important to women. And yet they're not getting proper advice. They go on Google and are getting confusing advice. Google-itis is one of the biggest problems in my practice. And you know women need a resource guide for every age group from birth to elderly – on what you should do; what do you need to know; how can you be empowered to demand optimal breast care. This book provides that information to every woman.
Now why would you say optimal breast screening starts at 40 not 50 years?
John West MD:
We've been doing screening mammograms now starting at 40 for average risk women and we start earlier for high risk. And we know way back in the European studies - approximately a 30 percent mortality reduction. And as we improve the quality of the mammogram with the 3D now we're reducing breast cancer mortality by 40 to 50 percent. And then if we add extra screening for breasts that are dense we can pick up even more cancers and if we had MRI for high risk women we can even do a better job. So there's a lot of potential out there. But there is a U.S. government committee, the U.S. Preventative Services Task Force that's recommending that women start at age 50 do it every other year and stop at 74. It's crystal clear what's going to happen if these guidelines are to go into effect on January 1st 2018. Young women will die needlessly. Cancer diagnosis will be delayed. Young children will grow up without a mother. This is tragic. It's based on faulty data. It's based on a study from Canada that looked at two groups of women - those that got a mammogram and those that didn't. And you would expect from everything we know that women who got the mammogram should have done better - a lower mortality. What they found was there was no benefit. And in fact there were 22 percent more breast cancers in the group that had the mammogram. So it is totally illogical. It turns out the study is totally flawed.
Nurses examined the patients before they went into the study and the ones that had lumps or suspicious changes were disproportionately put into the group that had the mammogram. So we know one of the principal investigators signed off and wrote a paper in the Canadian Journal saying you can't trust this study. Another recent report out of Europe said this study cannot be trusted and yet our primary care doctors in this government task force are acting like that's the holy grail; and they're saying well it doesn't work. It does work; it saves lives.
You're talking about saving lives. I've been told that in truth if you start at 40 you really save more lives; even though you find fewer cancers in 40 to 50, you actually save more life years. Is that true?
John West MD:
That's exactly right. In fact it's pretty simple. There are more years of life lost from women in their 40s than for all the years of life lost from 50 on. This is our target group; if anything we should be starting earlier and maybe tapering off later. That would make sense based on the data that we know. The other interesting statistic when they look at women who have died from breast cancer the vast majority have never had a mammogram. So you know when this study looks at people dying because of advanced cancer, they have to take into account they didn't have a mammogram, so that the ones that had the mammogram didn't get into that group.