Mammogram

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Mammograms Role as Savior Is Tested

• TARA PARKER-POPE
• New York Times, October 24, 2011

http//well.blogs.nytimes.com/2011/10/24/mammogram
s-role-as-savior-is-tested/?hpw
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Oversold?

• Has the power of the mammogram been oversold?
• At a time when medical experts are rethinking
  screening guidelines for prostate and cervical
  cancer, many doctors say its also time to set
  the record straight about mammography screening
  for breast cancer.
• While most agree that mammograms have a place in
  womens health care, many doctors say widespread
  Pink Ribbon campaigns and patient testimonials
  have imbued the mammogram with a kind of magic it
  doesnt have. Some patients are so committed to
  annual screenings they even begin to believe that
  regular mammograms actually prevent breast
  cancer, said Dr. Susan Love, a prominent womens
  health advocate. And women who skip a mammogram
  often beat themselves up for it.

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New Analysis

• A new analysis published Monday in Archives of
  Internal Medicine offers a stark reality check
  about the value of mammography screening. Despite
  numerous testimonials from women who believe a
  mammogram saved my life, the truth is that most
  women who find breast cancer as a result of
  regular screening have not had their lives saved
  by the test, conclude two Dartmouth researchers,
  Dr. H. Gilbert Welch and Brittney A. Frankel.
• The Dartmouth researchers conducted a series of
  calculations estimating a womans 10-year risk of
  developing breast cancer and her 20-year risk of
  death, factoring in the added value of early
  detection based on data from various mammography
  screening trials as well as the benefits of
  improvements in treatment.
• Among the 60 percent of women with breast cancer
  who detected the disease by screening, only about
  3 percent to 13 percent of them were actually
  helped by the test, the analysis concluded.

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Real Numbers

• Screening mammography helps 4,000 to 18,000 women
  each year.
• 230,000 women are given a breast cancer diagnosis
  each year.
• 39,000,000 are screened.
• Of the 138,000 women found to have breast cancer
  each year as a result of mammography screening,
  120,000 134,000 are not helped by the test.

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How can this be?

• Four types of cancers
• Slow growing found and successfully treated
  with or without screening.
• Aggressive Deadly whether they are found early
  OR late.
• Inconsequential Little spots that would never
  amount to anything, but must be treated if they
  are found.
• Marginal ones Deadly but course can be
  changed by treatment. Mammograms help on these,
  but youre talking about 1/1,000 healthy women
  screened over 10 years.

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Two years after

• The Dartmouth analysis comes two years after a
  government advisory panels recommendations to
  scale back mammography screening angered many
  women and advocacy groups.
• The panel, the United States Preventive Services
  Task Force, advised women to delay regular
  screening until age 50, instead of 40, and to be
  tested every other year, instead of annually,
  until age 74.
• The recommendations mean a woman would undergo
  just 13 mammograms in her lifetime, rather than
  the 35 she would experience if she began annual
  testing at age 40.

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Comments
Prashant Srivastava Chicago, IL
Karen, Staten Island, NY

• I think this debate misses one important point
  Just because breast cancer treatments have gotten
  better at saving lives does not mean that there
  is no benefit in detecting cancer early. Early
  detection still saves money and hardship for the
  individual as well as for the healthcare system
  (costs for early stage treatment are much lower
  than those for late stage treatment).
• The key question that needs to be answered is how
  do the early detection savings match up with the
  costs of screening everyone. If they are
  comparable (all soft costs like emotional
  hardship reduction aside), we as a society should
  continue to do screenings.

• I find this article and the comments troubling. I
  am a 7 1/2 year survivor. My breast cancer which
  was classified as Grade 3 (bad cancer), Stage 1
  the lump was the size of a finger. I was 41 years
  old with two small children. I thank god that I
  went for my annual screening and a very well
  trained radiologist was able to detect the lump
  which was in the upper portion of my breast very
  close to my underarm. Surgery Chemotherapy,
  Radiation, tamoxifen and femara has all
  contributed to saving my life, however without
  the mammography I probably would not have been
  around to receive all of this modern medicine.
• Saving just One Grandmother, Mother, Daughter,
  Sister or Friend is worth every screening test
  being done today!