Posted on 02/16/2014 12:50:25 PM PST by Kaslin
In 1999, newspaper columnist Molly Ivins was diagnosed with breast cancer and promptly exhorted her readers: "Go. Get. The. Damn. Mammogram. Done."
She also quoted a friend, columnist Marlyn Schwartz, who lamented, "If you have ever wondered what it would feel like to sit in a doctor's office with a lump in your breast trying to remember when you last had a mammogram, I can tell you. You feel like a fool."
Ivins' breast cancer killed her in 2007. She didn't say whether she had gotten regular mammograms before her diagnosis. If so, she was spared something many a dying breast cancer victim has endured: profound, awful regret at failing to undergo a procedure that would have saved her life.
It turns out now that this kind of regret is misplaced. Mammograms, as administered in advanced nations, do not save lives. Get one done, don't get one done -- either decision is very unlikely to affect your lifespan.
That's the verdict of Canadian medical researchers who followed thousands of women over 25 years and published their results in the British Medical Journal this past week. "Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care," they found. An accompanying editorial carried the headline: "Too much mammography."
Mammograms do detect some cancers that can't be felt in a physical exam, and some of these are life-threatening. So how come finding some cancers earlier doesn't save lives? Two reasons: Most instances of breast cancer can be successfully treated even when caught later, and some can't be successfully treated even when caught early.
The proliferation of mammography has coincided with a decline in breast cancer deaths, which gives the impression that the former caused the latter. In truth, improved survival rates stem mostly from improved treatments.
With regard to routine mammogram screening, H. Gilbert Welch, a physician and professor at the Geisel School of Medicine at Dartmouth, told me, "I genuinely believe that some women are helped, but the number is very small and getting smaller."
Mortality aside, early detection sometimes spares women aggressive treatments they would require if they were diagnosed later. But more often, it subjects patients to surgery and other measures they don't need.
If this process helped only a few women while doing nothing for the others, it would be easy to justify. The problem is that it harms far more women than it helps.
In a recent article in the Journal of the American Medical Association, Welch and Geisel colleague Honor J. Passow calculated that for every 50-year-old woman who avoids death from breast cancer through annual mammograms, at least 153 (and likely far more) suffer false alarms and at least four are "treated needlessly with surgery, radiation and/or chemotherapy."
In fact, over a decade of annual screenings, half or more of patients will be the victims of false positives that at best induce anxiety and at worst require surgery or other treatments for cancers that would not harm them. "My value judgment is that a population-based screening program that alarms half the population is outrageous," says Welch.
The point is not that the mass of American women should avoid annual mammograms. It's that they shouldn't do them without understanding that the procedure carries a small prospect of a large benefit and a large prospect of a small harm.
Women are not the only people who face this sort of dilemma. A widespread test for prostate cancer works almost identically. It detects a lot of cancers that are either unlikely to be fatal without treatment or very likely to be fatal even with treatment, while exposing many men to needless fear as well as treatments with serious side effects. The U.S. Preventive Services Task Force now recommends against it for routine screening.
Annual mammograms for breast cancer are expensive. Putting every woman through it annually starting at age 40 would cost a total of $10 billion a year. Starting the screenings at age 50 and doing them every other year until age 69 would cost $8 billion a year.
That's about twice what the government's National Cancer Institute spends annually on cancer research. Money spent on mammograms could be used in ways that would save more lives.
How should we feel about a health care system that has long put so much faith in such a flawed instrument? At least a little foolish.
Pretty much the whole article applies to colonoscopies as well.
A very, very small number actually avoid early death because of the procedure. The incidence of colorectal cancer if you do nothing is only 25/100,000. So only some fraction of 25 could be saved even if 100,000 go through the useless unpleasantness of colonoscopy prep and procedure.
You're right. For years and years, doctors, the media, and everyone else insisted that women should have yearly mammograms starting at age 40. In those days, I read an article warning that yearly mammograms could cause cancer, and it convinced me not to have one. But, believe me, it didn't matter what I read - Back then, those of us who wouldn't have a mammogram were accused of being irresponsible and stupid.
Now, all of a sudden, out of the blue come all of these articles on how mammograms are harmful or, at the very least, not really helpful at all. Hmmm...
In reality, mammograms catch some tumors and miss others. IMHO, based on personal experience, we each should be vigilant about our own health, but what that means for one person may be very different from what that means for another.
That’s what I was thinking. Follow the money indeed. All it’s trying to do is sell that book, it told me nothing about the method, NOTHING. All it did was put down current treatment. Ok, put it down, but tell me something instead!!!
I’m sorry, but your mother died because she believed her doctor, not just because of a mammo.
The same thing happened to me, same exact thing. “oh it’s a benign cyst” Yeah, like you know!!!! You don’t know! I wanted that thing OUT of my body, so went to a surgeon and it was cancer. Liars. I don’t allow my drs to treat me with “i think....”
I’m really sorry you lost your mom though. God bless.
I insisted a lump come out and my doctor was livid
He turned out to be right, but the insurance would pay for lumpectomy but not mri so I made him take it out.
It was benign but at least we knew
Cuban leaf, Gerson is a crank and has cured nothing.
Interesting thing is that even people who have something real to say are “selling a book”.
I’ve read “How to Win Friends And Influence People” by a guy that was “selling a book”.
Etc.
The radiologist who saw the first images of my lung cancer told me it was probably just pneumonia, which I was already being treated for, but he also said it was important for me to follow up immediately with an oncologist, to be sure.
I followed his advice.
The doctor who diagnosed my lung cancer told me to write out my will, go home, and wait for death.
I ignored his advice.
The doctor who treated my lung cancer insisted that my world needed to revolve around getting rid of the cancer.
I took his advice.
I’ve been cancer free over six years, and counting.
Thank goodness you followed your own instincts, Shimmer1.
Yes. I find that some still try to treat me with “i think....” and I don’t stand for it.
No. But the Canadians have been backing health care at a government level for thirty five years and dead Canadians use less health care than live ones. It is a Canadian study.
Mammograms are significantly less painful then end stage cancer and a damn sight more comfortable than an early grave!
If the doctor found a lump and dismissed it because of a mammogram without doing a biopsy, he is a quack who should have not only been sued into the poor house, he should have lost his license to practice medicine.
But you know what? It isn't easy. I've gotten in near-screaming arguments with doctors who were insisting that I was killing myself by not getting mammograms. With one doctor, I had to make appointments and not show up, just to shut him up.
He was a family friend, a very good man and suing him would not have brought our mother back.
Coincidentally do you remember hearing about a pharmacist in Kansas City diluting chemo to increase his profits? That was where she was getting her chemo, for him we signed the paperwork. No money to speak of, but he didn’t make a mistake, he committed a crime.
I had a friend who died because of that pharmacist. That was about the most evil thing a pharmacist could do.
His excuse was he was donating a lot of money to his church. He must not have been paying attention.
There’s a really good Law and Order episode (might have been Criminal Intent - yes, with Denofrio) that tracks this story exactly. Her widower and I share a manicurist so I see him occasionally. There ended up being a settlement. She was a good person. Very sad. It was a big story here in the metro area.
Looking back on the posts I realize I should clarify where I was coming from regarding Gerson. I see the whole Gerson thing as one of many examples of folks trying to tell us that cancer is not inevitable and can even be treated naturally. And diet is a HUGE part of both the causes and cures for it.
And medication is not always the best answer. The movie, “Curing cancer from the inside out” Is interesting. Also, if someone devotes their life to discovering information that can help people, there is really nothing wrong with paying them for their time and effort. i.e. a person is not automatically a quack simply because they want payment. That would destroy the credibility of pretty much every human being that ever lived except Jesus.
I certainly don’t mind him or her making money off of his knowledge, but the video puts others down for that, so I was pretty much just pointing out the hypocrisy.
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