Wednesday, April 02, 2014

Mammograms-- What's the Deal?

I have a confession to make.  I haven't had a mammogram in years.  Why?  Because over the years a number of studies have questioned their effectiveness.  I have also wondered about the wisdom of radiating a part of the body prone to cancer.  We know that radiation exposure over time increases the likelihood of cells becoming cancerous.  I also thought that it was nearly impossible to protect my liver from radiation from a mammogram and, because of my medical history, my liver was vulnerable to cancer.

I also found that, because of breast density, I nearly always was told to come back sooner than a year so they could double check something-- very stressful.  I always escaped having to have a biopsy.  And I  thought it odd that medical people would say that a biopsy increases your chance of later having cancer but that the reason would be because of the original condition, not because of the biopsy.  Really?  How could it be possible to tell which was the reason?

Let me tell you, I don't take breast cancer lightly.  My dear sister-in-law died of it way too young.

I'm relieved that more and more studies are questioning the efficacy of mammograms.

Here is a link to Reuters, Feb. 12, 21014, describing some of these newer results in a piece called "New study adds to evidence that mammograms do not save lives."
Instead, the study "found no reduction in breast cancer mortality from mammography screening," the scientists wrote, "neither in women aged 40-49 at study entry nor in women aged 50-59."
No reduction in mortality?  Then why would I have a mammogram?  It gets worse.

In addition to not reducing mortality from breast cancer, the study found, mammograms are leading to an epidemic of what the researchers call "over-diagnosis." Nearly 22 percent of the invasive cancers detected by mammography were harmless, meaning they would not cause symptoms or death during a woman's lifetime.    
In other words, not only did this study find that mortality is not reduced by mammograms, but that 22 percent of the women being treated for breast cancer would have been just fine without treatment.  So mammograms do not reduce mortality and also create a risk for unnecessary treatment.  I have been though chemo., for something else.  You DON'T want unnecessary treatment.  It's not a little thing.
Today's Wall Street Journal has an article on a study just published Tuesday.  "More Doubt on Mammograms' Value."  For me, here is the key point.
For women in their 50s, 10 breast-cancer deaths would be averted for every 10,000 women screened annually for 10 years. For women in their 60s, 42 breast-cancer deaths would be averted. But as many as 137 women in their 50s, and 194 in their 60s would be diagnosed and treated unnecessarily.   
Let's break that down.  Since I'm in my fifties, if I were to get annual mammograms for 10 years, I might be the 1 in 1,000 women (according to the figures above) whose life would be saved from a death from breast cancer.  For younger women the number of lives saved is even smaller.   In my sixties, I might be one of the 5 women (4.2) in 1,000 whose lives would be saved.  BUT...I could also be one of the 13 or 14 who received cancer treatment unnecessarily.  Chemo, surgery, radiation.  I eliminate my one in a thousand chance of dying from breast cancer or I eliminate the 13 in a thousand chance of unnecessary treatment.  I'm willing to take my chances on not being the one in a thousand.  Seems to me that the conclusion from the Reuters article says it all:
But in countries such as those in North America and Europe ..., the scientists wrote, "our results support the views of some commentators that the rationale for screening by mammography should be urgently reassessed by policy makers," since annual mammography "does not result in a reduction in breast cancer specific mortality for women aged 40-59 beyond that of physical examination alone or usual care." 
An accompanying editorial agrees that policy makers should stop pushing mammograms but points out that this is easier said than done: "governments, research funders, scientists, and medical practitioners may have vested interests in continuing" that push, since mammography is a multi-billion-dollar industry. Annual screenings also give women the sense that they are taking active steps to reduce the chance of dying of breast cancer.
Read the whole Reuters article here.
I am in neither a medical field nor am I an expert in statistics.  Am I missing something?  Seems to me mammograms are not worth it. 


Marla Rickloff said...

From my late 30's until my late 50's I got a yearly mammogram. A few years ago, I learned about all of these statistics and decided -"NO MORE!" I have had enough radiation for a life time! I now get a yearly thermagram. And am very comfortable with the amount of changes that this heat technology is able to detect in my breasts. And with no possible harm to the tissue.

Rosemary Bogdan said...

Marla, thank you for visiting my blog! Hope all is well with you and your family! I have heard about thermagrams. Are they covered by insurance? How do you find out about them?

Hi said...

Interesting, Rosemary. Food for thought, definitely.

Esther Gefroh said...

Rosemary, wish I had seen this earlier. I have an appointment tomorrow. Thanks for sharing.