One More Time With Feeling: Can We Be Done With Mammography Screening?

October was long over when the New York Times ran an op-ed about mammography screening and over-diagnosis. The op-ed makes a compelling case for ending

Why are all these doctors here?

population-based mammography screening for breast cancer, based on the on the numbers of women who will be treated unnecessarily as a result.

 

This happens because screening mammograms: that is, mammograms given when there is no evidence of a breast lump or any other problem in the breast find cancers that, untreated, will never be life-threatening. In the medical field, this is referred to as over- diagnosis. Women experience it as unnecessary treatment.

Neither the op-ed nor I is talking about the need for diagnostic mammograms, mammograms given when a woman has a lump or another breast condition that needs to be figured  out.

I wrote briefly on this topic a year ago in blog called Is October Over Yet? at. In that post, I talk about Komen’s responsibility for push mammography screening, and their refusal to educate people on the risks of screening.

The New York Times op-ed prompted the usually number of outraged letters from members of what I call “A Mammogram Saved My Life” chorus. No one who has undergone surgery, and possibly radiation and drug treatment or chemotherapy wants to believe they didn’t need treatment.

As I explained in the film Pink Ribbons, Inc.at the time of a breast cancer diagnosis, women fall into one of the three categories:

– They have a kind of cancer that, left untreated, will never be life threatening. If they are treated, the treatments will very likely make them feel bad. Cancer won’t.

– They have a kind of cancer that can be effectively treated with currently available treatments. If they get treatment in a timely manner, the treatment may make them feel bad for a while, but it will keep them from dying of breast cancer.

– They have a kind of cancer that is so aggressive, no matter how small the tumor is, that no currently available treatment can stop it. They will be made very sick by the treatments, seriously affecting the quality of their remaining lives.

Of course, everyone diagnosed who is treated wants to believe that they are in the second group. If their cancer comes back after treatment, they will learn that they were in the third group. But people in the first group will never learn that they are in that group: they will continue to believe that are in the second group.

Folks, these realities are about biology, not mammography. Mammograms have always had their problems: they are radiation based, they miss things that might be life threatening and find things that aren’t. We have been promised a better technology for more than 20 years, and we’re not close. What we need are diagnostic tools that can tell us whether a cancer needs treatment. And we need to reduce the amount of over-treatment while not jeopardizing the availability of treatment for cancers that can and should be treated.

We should stop doing population-based mammography screening and focus on screening those at highest risk of breast cancer.

What we know now is that mammograms alone never save a life. If a life is saved, it’s saved by treatment, no matter how the cancer is found. The chorus notwithstanding and Komen are damned.

© Barbara A. Brenner 2012

 

 

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6 Responses to One More Time With Feeling: Can We Be Done With Mammography Screening?

  1. Thank you for this One More Time with Feeling! I just got called to have my every other year mammogram and I always have such mixed feelings about doing them. After reading this I think I will pass and continue to ponder bests approaches to wellness and prevention, while continuing to dialogue with my practitioners and friends- THANK YOU!

  2. Koryn Hutchison says:

    I have to say I disagree. A mammogram found my cancer and a mastectomy found in situ lesions that (correct, we will never know if would have become invasive). But until a test is developed to say whether or not in situs will progress, mammography is the best we’ve got. More recently, 3D ultrasound found a lesion in my other breast. This technology has fewer false positives and has no radiation and is FDA approved. When will insurance step up to the plate for us dense tissue women for who mammography doesn’t help much?? By the time it does detect, it is often to late to save a breast . But it’s all we’ve got. For now.

  3. bbzinger says:

    I’m sorry you have entered the world of breast cancer, Koryn. Was your’s a screening mammogram, or did you have a lump or other symptom?

    I find your comment a little confusing. First you praise mammograms, and then you say you have dense breast tissue that mammography can’t help.

  4. Pingback: Do Screening Mammograms Do More Harm Than Good? | Cognoscenti

  5. Thanks for your post, Barbara. You explain this issue very well — and explanations about what screening mammography can and can’t do are badly needed. The message that catching cancer early is so ingrained in our thinking, it’s hard to let go. But it’s important to know the limits of what we’ve got to press effectively for what we need. Thanks for your work on this issue.

  6. Elizabeth (Aust) says:

    I agree…and so do many others “in the know”.
    I just heard Peter Gotzsche from the Nordic Cochrane Institute speak at the Evidence Live 2013 Conference in Oxford. His speech was clear: mammography is harmful and should be stopped. Approx. 50% of all screen detected cancers are over-diagnosed and if screening saves a few lives, the benefit is almost certainly taken away by those who die from cancer and heart attacks after over-treatment.
    See: Professor Michael Baum, UK breast cancer surgeon (2013) BMJ 346:1385
    3-4 per 10,000 screened avoid dying from breast cancer.
    3-9 per 10,000 will die from lung cancer and heart attacks as a result of radiotherapy/chemo.
    http://www.bmj.com/content/346/bmj.f385
    I noted the number of female doctors attending the conference who do not have breast screening. It’s disgraceful there is still a major disconnect with the “information” most women receive about screening, with many countries having screening authorities who arrogantly tell women to get screened and use guilt and scare tactics to reach govt-set targets. It seems to me there is no respect for individual women and our legal right to make an informed decision about screening and that includes saying NO…
    I have made an informed decision not to screen…even at this late stage though, I see Breast Screen Aust are delighting in the fact numbers screening are up after a celebrity had a cancer diagnosed after a mammogram…it seems fear or taking the advice of a celebrity is fine as long as they get the numbers up. This is not making an informed decision to screen. It’s time women’s cancer screening was pulled into line, these attitudes are disrespectful, unethical and unfair to women.

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