Breast Wellness with Dr. Dill-Macky

Dr. Marcus john Dill-Macky

During Breast Cancer Awareness Month we want to share an interview that was held with one of Radiology Ltd.’s breast imaging specialists, Dr. Marcus Dill-Macky. Dr. Dill-Macky has a passion for furthering education around women’s breast health issues. He recently shared his thoughts around the challenges women face regarding their breast health and getting screened. Dr. Dill-Macky also addresses the USPS Task Force announcement made several years ago about women’s screenings and the lasting impact it’s had.

Are women more confused about mammography?

Unfortunately yes. The USPS Task Force has created unnecessary uncertainty in women who need the real facts to help them make an informed decision regarding screening mammography.

What are you seeing in your practice? Fewer or more women seeking mammograms?

This is difficult to answer as there has been a drop in screening numbers nationwide that coincided with a slower economy. What we have seen however is confusion voiced by many women who come for screening exams as to whether they are doing the right thing.

It is so important to consider the basic facts about breast cancer and screening;

Breast cancer is a spectrum of diseases from preinvasive or “insitu” cancer that may or may not progress to more aggressive types of cancer that spread rapidly.

If left long enough, all invasive cancer will eventually spread and result in death.

The best way to prevent cancer deaths is to discover and treat cancer when it is small and has not extended beyond the breast.

Mammography (though not perfect) is the only scientifically proven effective way to discover cancer early, this is why screening exists.

Women who undergo screening have a 30% reduction in breast cancer mortality rates.

Additionally by finding cancers earlier, treatment may be simpler and less expensive.

Screening gives women their best chance to find cancer early.

Are more women questioning whether they need a mammogram?

Yes however that is the wrong question.

If you want to reduce your risk of dying from breast cancer then you should have regular mammographic screening.

The Task Force highlighted the issue that if you are screened you may be called back for extra views or even infrequently undergo a biopsy. This is associated with inconvenience and anxiety however this is what is required to find cancer early. Only one in ten women are called back and few of those ever undergo a biopsy. This potential “harm” must be balanced against the benefits of screening when making an informed decision about whether to screen or not.

Breast cancer incidence increases incrementally with age and 75% of cancers are in women who have no known risk factors. To recommend against screening average risk women aged 40 to 50 is totally unsupported in the scientific literature.

Many women ask us, what would we do? “Would we screen from age 40, would we screen annually?”. Our answer is definitely yes and yes.

Are they talking with their doctor more and understanding the risks/benefits?

That I believe that was the intention of the task force recommendations. I totally support making informed choices which I am sure women and their physicians were doing before those recommendations.

What’s the impact of waiting two years for a mammogram as opposed to 1? Are women questioning whether mammography is as useful as they thought (in both/either a good or bad way).

Younger women are more likely to get more aggressive cancers and they have denser breasts that are more likely to hide cancers. In my view, and from my understanding of the scientific evidence, if you have mammographic screening it should be annual to allow the best chance of finding cancer early…which is what screening is all about.

Has there been more confusion from women or did the debate empower more women to ask questions and decide what is the best screening routine for them as an individual?

There has been more confusion because there is the inference that mammography is ineffective below age 50. That is totally wrong.

I believe all women should elect to be screened. Additional individual choices are more relevant to patients who have high risk factors for breast cancer and might consider MRI as part of their screening regimen.

Can you share a couple of stories of how the guidelines have affected women these past 6 months–good and bad?

Sensibly our referring physicians did not adopt the recommendations and as yet the insurance companies we deal with have not altered their existing policies. Common sense and support for real scientific data is prevailing in Arizona. There however is still a lot of unnecessary anxiety and confusion amongst our population that would benefit from screening.

Tell me about the site Radiology Ltd created in response to the Task Force’s updated guidelines. Why did your organization feel the need to create the site?

In response to our patients confusion, and in support of the immediate protest from the medical community, we funded a local advertising campaign and web site, reinforcing the benefits of screening and providing information and support regarding breast health. Additionally the site provides links to local resources, news and events relevant to breast health and presents some local survivor stories. I particularly like the feature allowing women to send an e-card to friends inviting them to consider screening for themselves, for life.

Are women asking about/relying on other screening methods (which may or may not be as useful for them individually, as cost efficient, etc, such as MRI, ultrasound, breast self exams, etc.)?

Medical literature supports MRI as an additional screening test for women who have a 20% or greater lifetime risk of breast cancer. This risk can be easily assessed by their doctors after which individual screening regimen options can be discussed.

What are some of the concerns about the task force guidelines from your vantage point?

There should be no confusion, screening mammography saves lives and should be considered as an annual examination from age 40. Screening mammography as a true preventative medical test, must be available to all the women who request it.

Are you worried that women may forget to plan their mammogram if it’s scheduled every two years instead of one?

All women who elect to have screening with Rad Ltd are sent reminder letters every year and have all other issues that may arise from screening tracked until resolution. Radiology is all we do and we take breast health very seriously. We know that we make a difference in the lives of those women who elect to have mammographic screening.