Mammogram benefits and risks are confirmed by mainstream doctors

Imaginary life saver

Ask any car salesman if you need to buy a car and you’ll get a resounding “Yes!” After all, his livelihood depends on putting you in the driver’s seat.

Same with mammograms.

The American College of Radiology advises all women over the age of 40 to get a yearly mammogram. But ACR is a national organization that represents thousands of radiologists, radiation oncologists, and other medical professionals whose livelihoods largely depend on putting your breasts between the plates of a mammography unit.

And right now, their sales pitch is in high gear on TV and radio.

The campaign is called Mammography Saves Lives–a title that sums up the pitch in three simple, misleading words.

To my thinking, the best thing about the MSL campaign is the reaction from the medical community. Several mainstream doctors are finally stepping up and stating the truth about mammograms.

And just about everything they’re saying confirms exactly what I’ve been saying for years.

Over-diagnosed and over-treated

Let’s get right to the main question: Does mammography really save lives?

You probably know MY answer to that, but let’s hear from Dr. John D. Keen of Chicago’s Cook County John H. Stroger, Jr., Hospital.

Dr. Keen recently wrote this in the American Board of Family Medicine: “The premise of a near universal life-saving benefit from finding presymptomatic breast cancer through mammography is false.”

He explains that, statistically, the chance that a mammogram will save a life is very slim. But women under the age of 50 who have a mammogram are 10 TIMES more likely to be over-diagnosed and over-treated!

Of course, the MSL campaign features testimonials by women who absolutely believe mammograms saved their lives when breast cancer was detected.

But is this an emotional belief, or is it based on fact?

Here’s what Dr. Karsten Juhl Jorgensen of Denmark’s Nordic Cochrane Center told Medscape Medical News about the typical woman who is diagnosed with breast cancer: “There is no way of knowing if the symptom-free cancer she was diagnosed with would ever have developed into clinical disease. And if it was destined to do so, we cannot know if the screen-detection changed the prognosis in her particular case.”

Dr. Jorgensen adds that mammography offers “marginal benefits and serious harms.” And: “A decision not to get screened can be as sensible and responsible as the decision to get screened.” (I’m saving this quote and bringing it to my annual OB/GYN appointment next year!)

And finally, Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, gave Medscape these estimates for mammogram screening of 2,500 women, beginning at age 50 and continuing for 10 years:

About 1,000 false alarms
About 1,250 biopsies
Five to 15 women would be over-diagnosed and needlessly treated with surgery, radiation, chemo, or a combination of those treatments

And through all of that only one life would be saved.

Medscape asked Dr. Welch to imagine what message he’d like to see in a mammogram campaign.

Dr. Welch: “Mammography has both benefits and harms…that’s why it’s a personal decision. Screening mammography may help you avoid a cancer death or may lead you to be treated for cancer unnecessarily. But both are rare; most often it will do neither.”

I appreciate Dr. Welch’s balanced, rational approach. But unfortunately it doesn’t allow for the compression contradiction.

In medical school, students are instructed to examine breasts gently because excessive pressure may cause existing cancer to spread. And men, trust me on this one, the pressure between those two plates on a mammogram unit is excessive and then some!

This is the compression contradiction. And it’s the very heart of what’s wrong with mammography. It physically hurts, and while supposedly saving lives it may actually set in motion a life-threatening cancer.

Sources:
“‘Mammography Saves Lives’ Slogan Doesn’t Tell Full Story” Zosia Chustecka, Medscape Medical News, 11/18/10, medscape.com