Mammograms around the world

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JEB SHARP: There's a lot of confusion here in the U.S. over a new set of guidelines regarding mammograms. A federal panel suggested this week that women should start getting yearly mammograms after turning fifty, not forty as currently recommended. David Dershaw is Director of Breast Imaging at Memorial Sloan-Kettering Cancer Center. He says that in much of the rest of the world, women start screening at fifty.

DAVID DERSHAW: Also, in much of the rest of the world, screening isn't done every year; it's done every two or three years. So there's less mammography that's available to screen women in much of the rest of the world.

SHARP: And what's the basic rationale that makes things start at fifty in most of these places you're referring to?

DERSHAW: It saves money.

SHARP: So it's not a medical decision, it's a financial decision in terms of sort of public health model?

DERSHAW: That's correct. When push comes to shove, there is an acknowledgement that screening works for women in their forties but because breast cancer is less common in the forties, the cost of finding each cancer is higher and with limited resources, the money is spent where it is most effective.

SHARP: And where in the world are women being screened in their forties?

DERSHAW: The most well known program is the program in Sweden which is a very well documented and a long, ongoing program. And in that program, data have shown that the death rate from breast cancer has really plummeted with the use of mammography for women forty and older.

SHARP: And when we talk about screening, we're talking about the U.S. in comparison to other western industrialized countries. And breast cancer rates are highest in these regions but breast cancer is on the rise around the world. What are the opportunities for screening and early detection like in those other parts of the globe?

DERSHAW: They are variable and usually sparse and that's a function of the lack of monies to acquire the equipment and it's also a function of a real lack of trained radiologists to read the films and trained technologists to make the images.

SHARP: It's kind of striking when you read up on who's getting mammograms, where, at what age and then places where it's not even on the radar and I wonder just in your work and your contacts overseas, has anything really struck you about the differences really, just in what's available in terms of preventative care across the world?

DERSHAW: Oh, of course it's profoundly different as you move around the world and discussing it is one thing but actually seeing it is absolutely unbelievable. I remember being once in a former Soviet colony and the women who were lined up to get mammograms all had advanced breast cancers and the mammographer said all these women will be dead within a couple years. Completely different world in terms of cancer. But more importantly, it was also a different world in terms of the water was contaminated, everybody was smoking, the diet wasn't healthy, so it was this pervasive environment that is really alien to the way that we live our lives and the way that we see our lifestyle. We are lucky to be in a situation where cancer screening is important because it means we live to be old enough to get cancer and that's not true in many parts of the world.

SHARP: Just finally, David Dershaw, where do you, yourself come down on this controversy this week over screening?

DERSHAW: There's no doubt to me that mammographic screening done every year starting at age forty saves women's lives and saves a lot of women's lives. I work at a cancer center so I see this every single day and I strongly encourage women to do all that they can to diminish their likelihood of dying, not only of breast cancer by getting a mammogram every year, but of other cancers, pap smear, colonoscopy, stop smoking, all of that is part of living a longer and a happier life.

SHARP: Dr. David Dershaw at the Memorial Sloan-Kettering Cancer Center in New York. Thank you very much.

DERSHAW: My pleasure.