Mammograms — They call this a new problem???!!!

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I was going to write this post about clinical trials – since I’m trying to get into one for ALS. But breast cancer activism is in my blood and a story that I saw in the New York Times this week just screamed at me for a comment. So stay tuned for the blog post on clinical trials, while I rant briefly about yet one more mammogram study.

The headline of the story in the Times on May 10 was “Screening: New Threat Rises Between Mammograms.” The report is of a study of what are called “interval” breast cancers – the ones that show up between regularly scheduled mammograms.

Women do research. Let's be sure it matters.

This was a study of “screening” mammograms – which are done when a woman has no symptoms. It’s not a study about diagnostic mammograms, which are done when a woman has a pain or a breast lump or thickening that needs to be examined.

In Canada, where the study was done, the normal “interval” between screening mammograms for women over 50 is two years.

A brief aside in this brief post: The “every 2 years” thing is interesting. You might want to know that Canada and most European countries follow this pattern, and have outcomes in terms of breast cancer mortality that are no different from the U.S., where we usually screen women over 50 every year..

So the study in question was looking at breast cancers found in women some time between one regularly scheduled mammogram and the next one two years later. It distinguishes “true” interval cancers from those that were actually evident on the first mammogram, but not seen by the people reading it.

As they say on the NPR radio program I sometimes hear, let’s look at the numbers. This study found the following.

Total women screened 431,480
Breast cancers found on screening 450 (0.10% of women screened)
Interval breast cancers found 288 (0.07% of women screened)
Interval breast cancers missed 87 (0.02% of women screened)

From these numbers, it’s clear that the “problem” of “interval cancers” identified by the researchers and the news headline is not the real one. The real problem is that over 99% of the women screened every two years didn’t have cancer, which means a hug cost to society and a lot of radiation exposure for women could have been avoided. And – shockingly to those who have not followed the real mammogram story – of the cancers founds in this group of screened women, mammograms missed a third of them.

So we have one more study that tells us that mammograms don’t always work. It also confirms the huge cost – to society and individuals – of screening programs. How much research money is going to be spent proving what we already know, instead of looking for better ways to detect breast cancer? Or maybe doing studies of the 1/3 of breast cancers found by women themselves, despite all the mammograms they have.

The person who did this study, Anna M. Chiarelli, did have some good advice: “Better screening technology is needed. Until it arrives, women should seek immediate care for cancer symptoms even if they recently had a negative mammogram.”

Ms. Chiarelli  is absolutely right that women should seek immediate help if they have symptoms that might indicate breast cancer, no matter what their most recent mammogram says.

Aim this at a woman's breast? I hope not!

But the need for better screening technology is simply old news. We’ve been promised it for years. The National Cancer Institute had a program for a while called “Missiles to Mammograms” that promised to bring the benefits of military technology to the breast cancer detection field. We’re still waiting.

Mammograms are a limited technology. While having a mammogram every day would eliminate “interval cancers, we still wouldn’t find all the breast cancer.

So let’s advance the field. The public has been oversold on mammograms. It’s time to face reality, and push for better screening methods – methods that are more accurate, can be targeted to those a greatest risk of breast cancer, and that aren’t based on radiation – which, after all, causes cancer.

Can we finally move post the mammogram discussion. I hope so, but history tells me the answer is probably no.

© Barbara A. Brenner 2011

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9 Responses to Mammograms — They call this a new problem???!!!

  1. BobRN says:

    The most frightening number to me is the 87 “interval” cancers that were missed. Unforgivable.

  2. mary Whitehead says:

    Ringing such loud bells for me !!! I found my lump, had mammograms and sonograms the same day; rediologist “saw nothing” For anyone reading this please NOTE: Even though I made it clear there was a palpable lump, the radiologist did his “stove pipe” diagnostic, based ONLY on what he could SEE; he never did an exam, even though I had stated that the entire reason I was in his office was because I had found a lump. His report noted the pro forma status: since he didn’t see anything on his screen, I should come back in six months to a year!

    This is an example of a patient discovering what turned out to be invasive lobular carcinoma; the radiologist missed the opportunity for making sure that the patient had an immediate biopsy, which could have been fruitful. It took me 6 MONTHS to get the proper diagnosis, and get to surgery.

    And, to also be noted: when I found the tumor, it had been growing for at least 5 years; it makes one wonder if interim cancers really are found, or whether there is a “condition” of which the medical team “takes note”. I had been having regular mammograms; I was 62 when I found the tumor, and had diligently been having annual mammograms since I was 50.

    Have at it, Barbara! Lovely to see and hear your advocate voice making noise!

  3. abby abinanti says:

    well that qualifies as maddening as hell….

  4. Teresa says:

    I object to routine screening for breast cancer per se. It’s an imposition on women whether over the age of fifty or under that age. I’m absolutely shocked that women are called for annual screening in the US. It’s bad enough that they get called for screening every two or three years as in Europe and Canada. Are men called for regular prostrate cancer screening? No but there are campaigns for them to check themselves for lumps and that’s it.

    It’s up to women of all ages to examine themselves to look for lumps themselves and then go to a GP for a further examination and then maybe a referral to a specialist.

    Are breast cancer and cervical cancer the only diseases that women can get? No. They aren’t even the most common diseases. Then why not have routine cardiograms, VD testing (even for celibate and monogamous women) and screening for bowel cancer as well. It’s because breast cancer is seen more as a sexy topic. I’m being facetious here just in case anybody gets the wrong idea.

    Health services need to be democratised and decentralised more so that more power is put into the hands of patients, both men and women.

  5. Judy Griffin says:

    I would like to see more widespread use of Breast Thermography. Even though it has been used since the early 70s and was FDA approved in 1982 for breast cancer detection and risk assessment as an adjunct to mammography it remains rather obscure. What I love about Thermographies is that you cam learn your risk long before you develop a cancerous tumor which means you can establish some preventive measures rather than just waiting for early detection. It makes so much sense that I can’t understand why it isn’t used universally.
    I wrote about this topic in this article. http://tinyurl.com/5st8v87

  6. helen jacobs says:

    and for those of us that haven’t kept up with the research – here I’ve been feeling a little guilty and bad about myself because it has been a few years since my last mammogram. There’s a new Diagnostic Imaging center at our hospital, and I was thinking it might be time. But now I’m not so sure.
    thanks Barbara (and friends) for always making me think.

  7. Kathi says:

    I feel like a broken record sometimes talking about this. And still not getting the message across to people who think any of us is trying to say that we’re ‘against’ mammography. What we’re against are broken promises and outdated technology.
    This is my latest post about mammography: NBCC Conference Notes: Hard Data

    Keep hollering. I’m right there with you.

  8. Kris says:

    Im 32 and found a Lump, Im going for my first Mammo today and reading all this scares me. I hear the younger you are the more invasive it can be. For those who had been getting regular check ups at 50 and had it for yrs and found it at 60 is very upsetting to me.

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