“Mammogram’s Role as Savior is Tested,” an article published in today’s New York Times health section, questions whether our reliance on mammograms as an early detection tool translates to saving lives. Researchers’ answers? Not for the majority of women. So, should we stop having regular screening mammograms? Or is there still value in this long-accepted part of our over-40 health protocol?
Examine your breasts regularly. Get a yearly mammogram. Report any lumps or other breast changes to your doctor immediately.
This is the mantra most of us over age 40 have long embraced, as we seek to protect ourselves from breast cancer. Sounds like a sensible plan, doesn’t it?
Well, yes… and no.
Back in November, 2009 theUnited States Preventive Services Task Force (USPSTF) released new guidelines recommending women begin screening mammograms for breast cancer no earlier than age 50, and that those tests be given not every year, but every other year.
A firestorm of criticism from women, breast cancer advocacy groups, and even physicians resulted in the government’s department of Health and Human Services (HHS), which had requested the new guidelines, to quickly back off those strict recommendations.
When the dust had settled, HHS’s stance was that women without any known risk factors for breast cancer should discuss screening with their physician starting at age 40; and each woman should make her own decision about screening, regardless of the USPSTF’s recommendations.
Now (perhaps in recognition of Breast Cancer Awareness Month?), mammograms are back in the national media. A piece published online Monday in The Archives of Internal Medicine – Likelihood That a Woman With Screen-Detected Breast Cancer Has Had Her "Life Saved" by That Screening – flames the coals again, threatening to derail the “early detection saves lives” work the American Cancer Society (ACS) and other major cancer organizations have been doing for decades.
And you know what? Maybe it IS time for a change.
After all, a couple of years ago the ACS backed off its recommendation for monthly breast self-exams, after it was shown that women who performed the monthly exams were no less likely to die of breast cancer than women who did. Now, the ACS recommends simply “knowing your breasts,” so that you’ll notice if there’s a change.
And, if you do notice a change? With so many different causes for breast lumps, most premenopausal women are now advised to hold off on reporting lumps to their doctor, to see if they disappear during the course of the menstrual cycle.
So the whole early detection process has evolved, undergoing subtle but significant changes. Why not include mammograms as well?
Dr. Gilbert Welch, co-author of the new study, is a longtime advocate of evidence-based health care – basically, the use of data and statistics, rather than emotion, to steer medical decisions. His study concludes that on average, about 3% to 13% of women diagnosed with breast cancer, across all age groups, actually have their lives saved by a screening mammogram.
The study’s conclusion? “Most women with screen-detected breast cancer have not had their life saved by screening. They are instead either diagnosed early (with no effect on their mortality) or overdiagnosed.”
Stark facts. The Times article puts them in real numbers: each year 4,000 to 18,000 American women are actually saved by screening mammography – of a total of 39 million who have mammograms.
Is the expense – emotional, physical, and financial – worth the benefit?
Many say no – including the National Breast Cancer Coalition, and Dr. Susan Love, author, professor, and long-time “breast cancer guru.”
According to Dr. Love, if less money and resources were spent on screening mammograms, and more on research into treatment and possible prevention of breast cancer – particularly the aggressive cancers affecting younger women – we might make more progress with the one statistic we’re all most interested in: the 40,000 American women who die of breast cancer each year.
I accept all this intellectually. But emotionally, it’s hard… very hard. I may very well be one of those 4,000 to 18,000 American women whose life was saved by a screening mammogram. My cancer was virtually undetectable, even with the mammogram that revealed an ever-so-subtle change.
Yet the cancer had already spread. Had I waited another year… 2 years… however long it took for the tumor to finally become apparent as I soaped up in the shower, would the cancer have been in my liver? My brain, my bones?
There’s no telling for sure. But it would have almost surely continued to spread.
So, what’s your takeaway here?
Do what makes you comfortable. If you’re happy to live by the odds, and assume that chances are excellent you won’t die of breast cancer, then you don’t really need a regular screening mammogram.
You’ll be exposed to less radiation over the course of your lifetime; you won’t experience the emotional distress of a “suspicious” mammogram, and you won’t chance having a potentially injurious biopsy.
Also, the fewer of us who have mammograms, the more dollars will (potentially) be available for research into prevention and treatment.
Missed your mammogram this year? No guilt!
But if family history or genetics put you at high risk for breast cancer; or if you feel unable to desert the security blanket of an annual mammogram, go for it. No one’s stopping you.
At the end of the day, we’re all responsible for our own health. No guidelines, no studies, no doctors can make the personal decisions that will help determine our future: how healthy we are, and how long we live.
We’re taught from an early age to “follow doctor’s orders.” But in this new age of Internet-fueled enlightenment, we each have the chance to direct our destiny – at least to the extent it’s directable.
Cancer is a roll of the dice, a game of chance… same as relying on a yearly mammogram to prevent dying from breast cancer, according to Dr. Welch.
How lucky do you feel?
Published On: October 25, 2011