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.
Fair point. But I believe they are saying the same thing is happening to them, and in spades (i.e. the death of the senior Gerson looks like murder).
Thing is, somebody is right. It may be a little of both, or it may be mostly one, but somebody is right.
MRI are 100% accurate, no false positives
DIL is CNA nursing home min wage no health ins full time only nurses are offered over priced ins.
She got kicked in the breast by a patient, filed the WC report. Next day she wakes up to large mass in that breast, hematoma likely suspect since it was a very hard bruising on skin, ER run, CT, WC covered. Rest is not. She is sent to Evansville IN Women’s health center, after several mammos + MRI they found a walnut size tumor, milk ducts. Lobule, nipple involvement, biopsy next, stage 3, both HER 2 & hormone receptors, Mascetomy only recourse, followed by 12 months Chemo she is on # 6, + 6 was of another drug then 5 yrs hormone suppressants.
Had to get their conservative Stat Rep to cut through Medicaid BS to get her covered. Son lost his 40 hr+ health ins 1.5 yrs ago works PT. no one wants to hire a type 2 diabetic, Medicaid does not cover US makes, only Illegals! Ind spends $1.30M per yr on Illegal Medicaid adult men included!
I have bad Fibro cystic breast pain along with fibromyalgia, mammos are not designed for large DD boobs, last 1 I had left bruised on both that took 2 wks to go away, + the pain over rode10mg LoreTabs, promethizine & 10 mg Valium I nearly passed out from the pain! This was the new “comforts style” medieval torture machine.
Every male Gyn who orders 1 should have to stick their “jewels” under it just once to find out how painful those tortute machines really are!
It is NOT painless if U have 34 DD boobs with Fibro cystic breast disease & fibromyalgia I weigh all of 120 lbs, over gifted. They have to mash them in a device not designed for that size I had bruises 4 two weeks & nearly passed out even with 10mg lore tabs, promethizine, & 10 mg Valium to me it is a midEvil torture devise! Use a painless 100% accurate MRI
I pray that your DIL does well with treatments and that she will be blessed with many healthy years to come. Thank goodness the cancer was caught.
Mammograms are not 100% reliable. On the other hand, MRIs are known to give many false positives - that’s what doctors told me. In my case, the MRI caught two other spots of cancer that the mammogram never detected. But, in many other cases, the “spots” on the MRI turn out to be benign.
So, mammograms miss spots sometimes, and MRIs give many false positives. What to do? Unfortunately, insurance won’t cover an MRI every year unless the woman has tested positive for one of the BRCA genes. So, IMHO, because there are no guarantees with any test, each woman should do what she thinks is best.
Btw, after finding “the lump” myself, I went for my first mammogram. It had to be taken 6-7 times in order to get it on the picture. Haha - BRUTAL. Fortunately, I didn’t have the problems that you had - probably because I found a place that uses a newer, digital “soft-touch” mammogram with immediate results. That might be one you’d want to try.
Blessings to you!
Well, do as you wish.
My wife was well endowed when she had breasts. They where removed to save her life because the Mammogram found a small malignancy that her doctor didn’t find with a breast exam just two weeks earlier.
As I said, bruised breasts are much more comfortable than a coffin. As for an MRI. If you can get your health insurance to pay for a $4,500 MRI instead of a $400 Mammogram, good for you. I doubt they will be that understanding.
May you and your wife and children be blessed with many more years together. Those are beautiful photos on your profile page, by the way.
MURDER???!!! oh my gosh!!!
Thank you.
We have had a half decade of serious trouble and we hope the latest cancer scare is the last for the next, well, forever.
MURDER???!!! oh my gosh!!!
My DEXA score is bad, first drug was Fosamax, horrible side effects, and if you look all the OP drugs they have about the same ones. The new one they are pushing is Foreto, it comes in a diabetic style pen, 18 month program. My co-pays would amount to $1K. A daily shot, needles cost more than the med, and the promised bone regrowth of 9% DISAPPEARS once the drug is withdrawn after 18 months and you are put back on the other non bone regrowth meds. Where do I gain from it if it just disappears after the treatment is stopped. Waste of my money is all that weighing cost and benefits are balanced against each other.
I would prefer to see a standardized Vit/Min all in one Bone Supplement made that women can begin taking daily at age 30. Bones are made up of more than Calcium and Vit D. Which is why you see no great improvement in your Dexxa scores.
And with the cuts to Medicare they have moved Bone Density test to every 2 yrs. Unless your doc finds a ‘needed’ reason to do it every year. Same goes for men’s PSA testing.
Gotta read those first few pages of your Medicare or Tricare Life booklets to find out about those loss of services and test.
They have already cut Bone Density to every 2 yrs and men’s PSA’s too.
Are there any studies with breast cancer genes that go down the male line? I know that it is rare, but it does occur. Because that is a issue for 2 of my cousins and their daughters. Their moms married brothers, and they have traced the gene to the male not the female line, as none of the rest of my aunts and there were 5 have breast cancer in their gene pool. Both my female cousins had breast cancer, 1 a double Mastectomy because of the markers, the other just a lumpectomy and radiation. Several of their daughters are gene positive.
Move to MRI’s 100% accurate, painless, no false positives.
Mammos are cheap which is why they push them. You cannot deny they are a positive step, but should not be the sole testing method, especially if your family has a genetic link to BC.
And not all breast cancer patients are genetic linked. And they have to find a way to make them less PAINFUL for women like me. There is NO such thing as a painless Mammo.
Some prescription drugs have a cancer warning on them if you bother to read the print outs.
This applies to Lung Cancer as well, my dad was having chest x rays every 3 months at the VA. They did not find the cancer until it was past treating, it was not a fast growing one. They sent him home with a 6 weeks to live report, and started Hospice, he made 3 months, his heart finally gave out from all the narcotics they had him on. Yes he was a Pall Mall smoker and worked in the Steel Mills for most of his life after his WW 2 six yr stint.
Unless a biopsy is done a doctor cannot tell if a lump is positive for cancer or not.
Many women have bad Fibro Cystic Breast Disease, and we are the ones that most often show up as having lumps and needing Biopsies to prove if they are benign or cancer.
Sounds like the doc was a ill educated idiot.
That is like the internist whose knowledge of Thyroid Diseases would fit in a thimble compared to an Endocrinologist specialist. Which is why I have an ENDO, under dosing by the internist for to many years let it get critical. http://www.acponline.org/patients_families/about_internal_medicine/subspecialties/endocrinology/
Endocrinologists specialize in hormones
Endocrinologists must first complete seven or more years of medical school and postgraduate training and become board certified in Internal Medicine. “Then, for an additional two to three years, they study conditions specific to the endocrine system — tissues and major endocrine glands, including the pituitary, pineal, thyroid, parathyroids, thymus, adrenals, pancreas, ovaries, and testes.”
If your colon screen is clean, there is 10 years before another is ordered. I take Nexium max dosage, and it has caused Barret’s Esophagus, that needs Upper GI biopsy every 2 yrs, depending on the biopsy report. Many drugs have GERD as a side effect, I seem to have them prescribed a lot. They over rid the 80mg of Nexium I now have to live on, because they ruined my GI system.
Hubby had polyps, so he was put on a rotating schedule, 2, 4, 6 yrs out he has been clean. Next one if it shows clean will set him back on the 10 year course.
As to the Pap test, there are 2 schools of thought on it when a woman has had a complete Hysterectomy. 1 GYN will want one yearly, another will tell you, you don’t need them any more, as every thing was removed. Very conflicting for women to know who is right or wrong. And once you get past child bearing years and had a complete Hist, and are not on HRT it is hard to find a OB/GYN that wants senior women they see for the yearly mammo once a yr. Which is why we get sent just to centers who do Mammos.
First thing they do after a mammo finds a lump is a MRI, it was how they found that the milk ducts, lobule and nipple were also involved. The Biopsy just proved what stage. When the surgeon did the Mastectomy he checked the lymph nodes and found only 1, but took 3 to be on the safe side.
That is what the ‘new comfort machine’ is. The pain comes from being large breasted and Fibro and Fibromyalgia. Heck even a BP cuff is PAINFUL if pumped up to high. FMS is a very misunderstood auto immune. And the treatments only make it worse as they are habit forming mind drugs, or Lyrica which has a 50% failure rate due to the horrendous side effects. Vallium 10 mg twice daily and keeping my Thyroid on the right dose has done wonders for the muscle and joint pain with out being addictive at that level, and does not have mental issues.
U think Medicare or Tricare Life will allow a MRI for that purpose unless the Mammo turned up a lump first? No way.
My DIL had a skin sparing Mastectomy, that was all that the oncologist ordered, surgeon wanted a radical as they are faster to do. My cousin opted for double, as her gene pool is down the male line. Rare, but it happens when sister’s marry a pair of brothers. Their daughters are hit and miss for the gene.
What about a CT with dye contrast? They don’t hurt. They sure picked up the small places that has diverticolois and fatty hernia I have. I’ve had 3 small lumps fat Narcrosis pea size, from a bad bruise at the aureola area, Ultra sound by a good breast surgeon was all I needed then. return visit showed all 3 dissolved.
I do my breast checks weekly after I had the GYN show me what the differences in lumps felt like. They are not comfortable but I do them.
I understand all the reasoning, but there should be alternatives for women like me. And there are a lot of us. I’ve had bad FCBD since I started developing breast very early at 10.
When they had the crank style they were less painful, since they have gone to the button pushing smashing type there has been nothing but horrid level 9 pain.
I don’t know but I have the dubious honor of being the only member of my family, from either side, to have breast cancer.
The doc was an old GP doc, when she reported the mass, he sent her in for a mammo which came back negative. He then sent her to a radiologist who did a sono, they found a cyst in the area and told her they would watch it which they did for over a year, the cyst remained unchanged.
They thought they had the diagnosis and were doing the right thing. My mom called me convinced she had cancer so I called a friend who was a surgeon and had her look at my mom. Withing 3 days, she had a mastectomy and was set up to see the oncologist.
She put up a good fight, she was diagnosed at 45 and made it to 56, she got to see all of her grand children. She also buried a husband during that period, he was diagnosed with colon cancer and passed within a year.
Then, typically, the very next step is a biopsy.
The surgeon didn't send me for an MRI until after the first biopsy confirmed cancer. I was warned that MRIs give many false positives. My doctors were surprised that there were two other spots, both cancer.
As for the pain you're experiencing with mammos - it must be due to the FMS alone. Size can't be causing the problem. Much larger women have mammos without experiencing that kind of extreme pain. If you have that much pain, maybe your doctor can make a case to the insurance company that you need to have an MRI instead. I hope everything works out for you.
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