Recent Questions About the Usefulness of Mammography

by Columbia Surgery on March 7, 2014

mammogramMany patients have inquired about a recent study in the British Medical Journal by Canadian researchers who found that mammography did not reduce death rates from breast cancer and may even have harmed some women by leading to unnecessary surgery, radiation, and chemotherapy. A vast majority of physicians, researchers, and breast radiologists have criticized the study sharply and cited massive evidence to discredit it.

It is important to keep in mind that the study is based on data from mammographic screening performed 30 years ago. At that time, two-view analog film-screening mammography was the standard of care. Unfortunately, the results from the study shed no light on the benefit of screening with current digital mammographic technique.

Differences in sensitivity between mammograms from the 1980s and now

Almost a third (30.6 percent) of the mammographically detected breast cancers in the Canadian study had already spread to lymph nodes and the vast majority were palpable (could be felt) by physical exam. Thus, it is no surprise that there was no survival benefit from mammography performed with the primitive technique of the 1980s. Results from contemporary studies1 show that with modern digital mammography, 18 percent of screening-detected cancers involve the lymph nodes; they are also more likely to be closer to 1 cm at diagnosis, compared with the mean size of 1.91 cm found by mammography in the Canadian study. The improved accuracy of digital mammography vs. analog film is well established for women under age 50 with dense breast tissue.2

Quality-of-Life Advantages to Earlier Detection

The Canadian study fails to acknowledge the many benefits associated with detecting tumors at smaller sizes. When tumors are detected earlier, patients are more likely to avoid mastectomy and to take advantage of breast-conserving options such as lumpectomy. They are also less likely to be prescribed radiation and chemotherapy.

Breast-Cancer Screening of the Future

Scientists at NewYork-Presbyterian/Columbia are involved in research to improve methods for early detection of breast cancer, including a PAP smear-type method to analyze nipple fluid to detect pre-cancerous changes. Another promising approach in development is 3D mammography. According to Sheldon M. Feldman, MD, Chief of the Breast Surgery Division, “Though digital mammography, the current ‘gold standard,’ performs reasonably well, we anticipate significant improvements in diagnostic capabilities in the near future.”

All patients should check with their physician before making any decisions about breast cancer screening or treatment.

      Sheldon M. Feldman, MD
      Chief of the Breast Surgery Division
      NewYork-Presbyterian/Columbia University Medical Center

Learn more about diagnosis and treatment of breast cancer at breastmd.org

    1. Nederend J, Duijm LEM, Louwman MWJ, Groenewoud JH, Donkers-van Rossum AB, Voogd AC. Impact of transition from analog screening mammography to digital screening mammography on screening outcome in the Netherlands: a population-based study. Ann Oncol 2012;23(12):3098–3103
    2. Pisano et al; DIMIST Trial: N ENGL J MED 10.1056/NEJMoa052911


Improving lives with Advanced TechnologyPrevious posts have informed our readers about an innovative breast cancer therapy, intraoperative radiation therapy (IORT), which became available at the Breast Center during the summer of 2013.  New York-Presbyterian/Columbia University Medical Center is one of the first institutions in the New York metropolitan area to offer IORT, which entails a single dose of radiation therapy that is administered immediately after lumpectomy.

In contrast to traditional radiation therapy, IORT offers important benefits to women undergoing surgery for breast cancer. According to Sheldon M. Feldman, MD, Chief of the Section of Breast Surgery, conventional radiation is delivered to the entire breast, and patients must come to the hospital five days per week for about six weeks. IORT delivers a single higher dose of radiation directly to the area where the tumor was removed. Both conventional radiation and IORT have comparable rates in reducing the risk of cancer recurrence, according to the randomized multicenter trial of IORT called TARGIT A, but IORT clearly saves patients a tremendous amount of time by avoiding daily trips to the hospital for six weeks. It is also far less expensive than conventional radiation. TARGIT A also found that IORT causes less skin toxicity than conventional radiation.

IORT is available to post-menopausal women who undergo lumpectomy to remove breast tumors less than two centimeters in size.

As of early February 2014, the breast center at NewYork-Presbyterian/Columbia has treated 18 patients and all have done well, according to Dr. Feldman.

Learn more about IORT and other advances in treating breast cancer at breastmd.org


Breast Cancer Management 2014: CME

January 16, 2014

TweetOver the past several years there have been many important breakthroughs in the treatment and management of breast cancer. New screening methods, the advent of minimally invasive biopsy techniques, advances in oncoplastic surgical procedures, and new information on the ever-important role of genetic analysis are just a few of the many exciting recent developments in […]

Read the full article →

New Procedure to Prevent Lymphedema Gains Media Attention

January 13, 2014

TweetA new protocol to help patients undergoing breast surgery is gaining widespread media attention as NewYork-Presbyterian/Columbia University Medical Center continues an important clinical trial of the LYMPHA protocol. The LYMPHA protocol combines microsurgery with advanced imaging in order to prevent, detect, and treat lymphedema. Lymphedema, painful swelling of the arm or hand, can be a […]

Read the full article →

WABC-TV Breast Cancer Special features NYP/Columbia Breast Surgeons

September 28, 2013

TweetTune in October 5th for the WABC-TV Special “BREAST CANCER: ANSWERS, UPDATES & PROGRESS” features NYP/Columbia Breast Surgeons On Saturday, October 5th, WABC-TV will air a special program, “Breast Cancer: Answers, Updates & Progress” at 7:30PM, EDT (also to be re-run Sun. 10/6 at 5:30am).  Hosted by Eyewitness News Anchor Diana Williams, the program focuses […]

Read the full article →

Whole Living Features Reiki, Raven Keyes, and NYP/Columbia Surgeon

October 30, 2012

TweetThe most recent issue of Martha Stewart’s Whole Living magazine featured an article, How Reiki Supports Health: Q&A with Author and Reiki Master Raven Keyes covering Raven’s extensive work with Sheldon Marc Feldman, MD, Chief of Breast Surgery and Associate Professor of Surgery, New-York Presbyterian Hospital/Columbia University Medical Center. Raven Keyes, author of the The […]

Read the full article →

Dr. Sheldon Marc Feldman at 2012 New York Reiki Conference, Part 2

October 26, 2012

TweetBy Raven Keyes, Author of The Healing Power of Reiki, A Modern Master’s Approach to Emotional, Spiritual and Physical Wellness Having given an overview of research and his observations about the power of Reiki to help patients before, during, and after surgery, Dr. Feldman then introduced someone he proclaimed to be “the most important person […]

Read the full article →

Dr. Sheldon Marc Feldman at 2012 New York Reiki Conference, Part 1

October 12, 2012

Tweet By Raven Keyes, Author of THE HEALING POWER OF REIKI, A Modern Master’s Approach to Emotional, Spiritual and Physical Wellness As a Reiki master who goes into the operating room with Dr. Sheldon Marc Feldman, Chief of Breast Surgery at New York-Presbyterian/Columbia University Medical Center, it was thrilling for me to have the opportunity […]

Read the full article →

Dramatic News in Breast Cancer Research

October 3, 2012

TweetThe latest scientific research has confirmed that breast cancer can be categorized into four specific types, depending on its genetic root. Perhaps even more significantly, the study revealed distinctive genetic changes that feed not only breast cancer but many other kinds of cancer. “We’ve known for awhile that there are several breast cancers, and we’ve […]

Read the full article →

U.S. News & World Report Recognizes 33 Top Doctors at NYP/Columbia Department of Surgery

September 21, 2012

TweetCongratulations to the thirty three surgeons at the Department of Surgeon for being recognized by U.S. News & World Report in their 2012 list of Top Doctors. Of these top-ranked surgeons, U.S. News further identified seventeen physicians as being in the top one percent in the nation in their specialties. U.S. News & World Report’s […]

Read the full article →