Who Needs A Mammogram?

Feb 13, 2014

That's a question only you and your doctor can answer. But news that a major, long-term study found no link between early screening (i.e., mammograms) and reduced deaths from breast cancer may have muddied the waters. So here are a few thoughts and resources to help shed some light.

- About the new study that finds early detection doesn't necessarily save lives. The NY Times wrote about this latest study, done over 25 years and following 90,000 women. The study sought to answer the question of whether finding breast cancers before they were big enough to feel (i.e., via mammogram) would result in fewer deaths. It randomly assigned women to having regular mammograms and breast exams or just breast exams. That's the mark of a good study, by the way - the randomized trial, the size of the sample, the years involved. They found it didn't really make a difference. Put another way: does early detection save lives? This study says not necessarily.

- Why wouldn't early detection save lives? Here's one explanation, in an excerpt from an op-ed ("Cancer Survivor or Victim of Overdiagnosis") in the NYT from 2012, written by H. Gilbert Welch a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and author of “Overdiagnosed: Making People Sick in the Pursuit of Health:"

"... proponents have used the most misleading screening statistic there is: survival rates. A recent Komen foundation campaign typifies the approach: “Early detection saves lives. The five-year survival rate for breast cancer when caught early is 98 percent. When it’s not? It decreases to 23 percent.”

Survival rates always go up with early diagnosis: people who get a diagnosis earlier in life will live longer with their diagnosis, even if it doesn’t change their time of death by one iota. And diagnosing cancer in people whose “cancer” was never destined to kill them will inflate survival rates — even if the number of deaths stays exactly the same. In short, tell everyone they have cancer, and survival will skyrocket.

Screening proponents have also encouraged the public to believe two things that are patently untrue. First, that every woman who has a cancer diagnosed by mammography has had her life saved (consider those “Mammograms save lives. I’m the proof” T-shirts for breast cancer survivors). The truth is, those survivors are much more likely to have been victims of overdiagnosis. Second, that a woman who died from breast cancer “could have been saved” had her cancer been detected early. The truth is, a few breast cancers are destined to kill no matter what we do.

- So what are the recommendations, exactly? Basically, for women with no family history, a mammogram every two years after age 50 and up to age 75. As a matter of fact, the US Preventive Services Task Force is in the process of updating those recommendations right now. Here's what they're considering. They were last updated in 2009. It's been uncertain for a while whether women 40 and older might benefit from regular mammography. But still, only you and your doctor can decide what's best for you.

- What's the harm in getting a regular mammogram anyway? Basically this: you could be misdiagnosed or overdiagnosed, and that could lead to treatment you don't necessarily need for cancer (or no cancer) that might not have killed you anyway. Here's what Women & Infants' Dr. Robert Legare with the hospital's breast health center says in a Q&A on W&I's web site about the most recent screening guidelines:

"The true risk of screening in women ages 40 to 50 is likely related to the risk of "false positive" results which can lead to further imaging including MRI, biopsy and more frequent follow up. This can certainly add to a woman's anxiety and frustration, as well as increase health care costs, but different women will make different decisions regarding how they feel about this issue. Again, when there are personal risk factors or family history, I would continue to favor screening in this age group."

So, bottom line, talk to your doctor. Educate yourself about the risks and benefits. Even better: know your family history and live a healthy lifestyle. Sounds simple, right? Ha - if only!