Giuliana Rancic’s breast cancer: do all women need mammograms before IVF?

By Deborah Kotz, Globe Staff

I was saddened to hear about Giuliana Rancic’s diagnosis of breast cancer that she announced this morning on the Today Show. The 36-year-old host of “E! News” and “Fashion Police” on the E! network had been publicly airing her efforts to get pregnant using in vitro fertilization on her reality show with her husband Bill Rancic -- yes, the guy who won Donald Trump’s first Apprentice show.

"E! News" co-host Giuliana Rancic AP Photo/Charles Sykes, File

Having seen the reality show a few times, I was rooting for them to finally get pregnant, but Rancic told Today Show host Ann Curry she had to put off these plans after a mammogram recently revealed she had early stage breast cancer.

“It was incredible instant sobbing, and it was like the world just crashed down around me,” Rancic said. “I couldn’t believe it, 36 years old, no family history.”

Hmm. So why did she have a mammogram in the first place? Rancic said her infertility specialist in Denver insisted she have one before having her third round of IVF.

“He said, ‘I don’t care if you’re 26 or 36, but I will not get you pregnant if possibly there’s a small risk that you have cancer because the hormones will accelerate the cancer,’” said Rancic.

She couldn’t believe that other specialists she’d seen for IVF treatments hadn’t insisted on a mammogram beforehand.

It turns out, the reason her other doctors didn’t recommend the screening X-ray is because mammograms are only recommended for women age 40 and over, according to the National Cancer Institute, American Cancer Society and other medical organizations. (A baseline mammogram that was once recommended for women starting at age 35 was dropped from recommendations years ago.)

Women under 40 who have IVF don’t need to have the screening, according to the American College of Obstetricians and Gynecologists. The American Society of Reproductive Medicine agrees: On its website, it recommends a breast exam and Pap smear prior to starting IVF therapy for women of all ages but only recommends mammograms for those age 40 and over.

Women who are at high-risk of breast cancer due to having, say, a BRCA gene mutation or relatives with the mutation are told to have screening earlier, but Rancic indicated that she wasn’t at higher than average risk.

“There’s no evidence to suggest that women under 40 should be screened with mammography, and there’s no reason to treat women with infertility any differently,” said Dr. Eric Widra, an infertility specialist who chairs the assisted reproductive technology committee for the ASRM. “Women get pregnant at age 36 all the time without having mammograms and those who have IVF to get pregnant aren’t at any greater risk of getting breast cancer than any other pregnant woman.”

Unfortunately, women may hear Rancic’s story and assume that they, too, should have a mammogram in their 30s. After all, her cancer was caught early and -- if it was a fast-growing aggressive kind -- that mammogram may have saved her life.

While Rancic was lucky, her urging women to get screened, as she did this morning, requires some qualifications. Mammograms are known to be particularly poor imaging tools for finding tumors in young women; that’s because women in their 30s tend to have denser breast tissue that looks similar to a tumor, which is also dense. Often mammograms miss significant tumors in those under 40 and even more commonly, they find a host of abnormalities that turn out not to be cancer.

I’m worried, though, that women may be swayed more by Rancic’s powerful story than the faceless, emotionless science.