 For many years now women have been suggested to, told and on occasion ordered (by their doctor), to have a regular yearly mammographys done. While many articles have been published with both pro and con opinions regarding routine mammography's this author has staunchly maintained that yearly mammography's are essential for early detection and prevention of serious life threatening breast cancer.
In a recent article researchers have suggested that the current Mammography Saves Lives campaign here in the United States (as well as in previous campaigns designed to promote screening for breast cancer), women have not been provided with all of the information necessary to help them make informed decisions. If this is so, then whether or not you show up for and have a regular yearly screening mammography, still needs to be decided upon and therefore more information is needed to help you safely and correctly decide what to do.
Opponents of Mammography — The Case Against Universal Screening
The problem, some doctors and researchers complain, is that the current ads, slogans and printed literature tend to oversell the benefits of mammography while down playing the hazards and risks. While many doctors and researchers agree that mammographies can save lives, the question in the opponents minds ends up being, “At what cost!” While some lives may be saved, they suggest, how many are subjected to risks which are unnecessary and potentially dangerous. What are the risks versus the benefits associated with mammography.
One physician suggested that a more accurate slogan then Mammography Saves Lives would be: "Mammography could save your life, but it's a long shot" and "Chances are it won't, but mammography could save your life." If this statement confuses you then join the club for the entire issue appears to be quite confusing and very emotional.
Opponents of routine mammography are now quoting a recent study performed in Norway which ends up suggesting that the decision as to whether or not to undergo screening mammography is, in fact, a close call. The fact is, the study suggests, that the premise of a near universal life-saving benefit from finding presymptomatic breast cancer through mammography is not real. It goes on to state that statistically, there is only a 5% chance that a mammogram will save any specific woman's life and that chance must be balanced against the potential harms associated with having the mammography test performed.
Another study suggests that women between the ages of 40 to 50 are 10 times more likely to experience over diagnosis and over treatment than they are likely to have their life saved by performing the mammography. One physician suggested that both sides, the proponents of mammography and those against it, each have some sort of vested interest in their position hence neither are completely credible.
Another physician suggest that in fact is, whether we like it or not, there is no real way to know whether or not any specific woman’s life was saved because she had a mammography. Even if a malignant tumor is found, treated and cured early enough to keep it from becoming a life threatening affair for her, how do we know that it really was going reach a state where it would treatment her life and end up killing her? The dilemma, as these above statistic demonstrate, is that only in 5 out of 100 women who had a mammogram performed each year, will have a malignancy found, if it is early, it might just as well have been found in some other way (doctors exam, breast self exam), might it not have just gone away, might she not out live it, hence how can we say because we found it we saved her life? There is, they say, no way of knowing whether the symptom-free cancer she was diagnosed with would ever have developed into clinical disease.
While we would all like to believe that many women's lives will be saved by mammography because a cancer she did not know existed was detected at screening, opponents say that in fact, the likelihood that any woman will be diagnosed with breast cancer unnecessarily is 10 times greater. And if it was destined to do so, we cannot know if the screen-detection changed the prognosis in her particular case. She may very well have survived her disease without screening or she may still have died from a reoccurrence of her “early treated” breast cancer 10 years later.
Opponents suggest that mammography screening involves subjecting normal healthy people to tests when they have no symptoms. Screening does not refer to patients who already have symptoms or known tumors. Mammography screening also subjects’ women to radiation while looking for a disease, that radiation is known to cause. How smart is this? Some opponents go so far as to say that more breast cancers are caused by mammography then are found by routine screening for mammography. Some say that we have seen a sharp up swing in breast cancer because of mammography.
Screening with mammography for breast cancer can, and often does, make the cancer diagnosis before any symptoms appear. But unless the eventual cancer death rate is lower in screened people, the only result, other than the adverse consequences, is an increase in the length of time that the patient knows that they have the disease.
The Norwegian study that was referred to above, suggested that a 10-year course of screening mammography provided for 2500 women, 50 years of age, would save the life of 1 woman from breast cancer. At the same time, up to 1000 women would have had a "false alarms;" about half of those women would have had to have undergone biopsy; and a diagnosis of breast cancer would have been over diagnosed in 5 to 15 women, who would have been treated needlessly with surgery, radiation, or chemotherapy, alone or in combination.
Half of all women screened regularly over a 10-year period will experience at least one false positive episode, meaning the mammogram showed something “suspicious” leading to repeat X-rays, other studies such as ultrasound, CT scans, MRI’s, even biopsies and surgical excision looking for suspicious breast masses that turned out either not to exist, or were benign tumors that did not need surgery. The anxiety caused by a false positive test has been well-documented.
False negative results also occur, with one in 10 breast cancers missed by Mammography altogether
Proponents of Mammography — The Case For Universal Screening
Proponents of mammography often start their arguments by suggesting that the estimates of potential and real harms are 1) not universally accepted, and 2) over estimated and blown out of proportion and 3) frequently questioned by expert in this field.
They often state categorically that, there is absolutely no doubt that screening reduces breast cancer mortality. One of the most frequently quoted statistics is that here in the United States, there has been a nearly 30% reduction in breast cancer mortality since the introduction of widespread mammography screening in the mid-1980s. While no one disputes that there have been improvements in treatment during this time, proponents quickly add that at least part of this reduction is due to screening.
Proponents generally admit that screening is not perfect and that there are potential harms associated with every mammogram done. However, the often quickly add that the discussion of benefit and harm is a very complex one. Risks are different for each individual woman, and the place for that discussion is in the doctor's office where the patients and the doctor can determine the woman’s potential risk and then make a decision to undergo or not undergo mammography. Every they frequently repeat that every woman needs to discuss risks and benefits with her healthcare provider whenever any tests is ordered, and this is equally true regarding mammography.
Proponents also repeat frequently that mammography does save lives, but that it can't save any specific woman’s life if she doesn't utilize it. We cannot tell women she should do it if there will be benefits, but that she should not do it, if there will be risks. Similarly one proponent stated, the proposition that "if you are 40 years old you should have a discussion with your doctor, but if you are 50 years old you should have a mammogram does make sense to me." The risks are different and the benefits are also different in these different age groups.
Right now they say there is a lot of confusion and in the future our message has to be clear or it will just create more confusion, it would be appropriate, one physician suggested, to tell women something along the lines of "mammography saves lives but it may not be a good thing for you individually" screening does reduce breast cancer mortality, but whether it is right for each individual woman is for her to discuss with her healthcare provider.
The truth is that mammography screening today does have benefits but it also has potential harms, therefore the decision not to get screened can be as sensible and responsible as the decision to get screened.
Since there is no single 'right answer' about screening mammography, our goal should be to encourage women to feel good about the answer that's right for them personally and their decision to undergo screening mammography should reflect this.
Comments By the Author Allen Lawrence, M.D.
It is likely that with time this conflict will move in one direction or the other, right now, we actually know less than we like to admit. The problem in the end is real, approximately one out of every nine women will likely develop breast cancer, While we have made great strides in treatment, we still have no accepted methods for prevention. Early diagnosis is the key, finding breast cancer prior to its invasion or spread and eliminating it with the least deforming, invasive and dangerous methods of therapy is the best we can do today. It would be terrific if there was one (or at least a few) such mechanisms to do this. If we could diagnose100% of the time at the absolute earliest opportunity make this diagnoses, or better still prevent breast cancer from occurring altogether. But this is not available right now.
In the mean time, today, Mammography, Thermography, Breast Ultrasound, Breast Self-Examination, and Physician Medical Examinations are all currently the best available for early diagnosis. As for prevention read our articles on health and wellness, prevention, healing, preventing cancer, crating a healthy diet, and holistic treatment of breast cancer for ideas you can implement to lower your risk.
In the near future we will run a series of article dealing with the root causes of cancer, specifically breast cancer and illness in general. Keep your eyes open for these article as we will tell you how illness is created and what you can do to prevent illness and heal your body, mind, emotions and spirit.
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