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.
Yes. Men who carry one of the BRCA mutations have a slightly higher risk of breast cancer, too, as well as prostate and other types of cancer. There's a 50% chance that their children will inherit it.
That explains much, all my aunts died of multiple issues in their late 80-90;s, it was their daughters who developed BC, years apart, and their daughters some have the gene some don’t, even if they do not have the gene themselves, can it be passed on to their daughters when they have them, they are just at that age to start families.
She had that too, I just forgot about it. Then the MRI, you are dealing with a women’s health center, and they all have differing methods.
No the FCBD pain has been a factor in my life since I was 12, I was wearing a 34DD then. I was not over weight either. The FMS just aggravates it, that I did not develop until my late 40’s, and I’d already had 2 mammos before then the old crank down style. And the pain was just as bad.
I do know that I was border line Hypothyroid since I hit 20, they did not start treating it until I was in my 40’s when it really took a nose dive, the internist always under dosed too. Which is why I now have am ENDO, better care.
My current internist is running unneeded T panels I did not know he was. Jan’s visit I got a call from his nurse, your T panel is high, and he wants a Radioactive Thyroid scan done. BELLS, ROCKETS, WHISTLES go off, he has never touched my thyroid, never asked the questions the ENDO ask, nor did he look up any new meds on my chart. I had 1 new one I’d been on 2 months from the Gastro Levsin S/l. Took me all of a minute with Google search to pull up lots of pages stating it runs your synthroid intake up. I had also told him I saw my ENDO first week of March. There is no reason for him to run T panels, I see the ENDO frequently enough, and he has never felt the need for such a scan.
What is the need 4every 3 months chest x rays and EKG if I have no health history for lungs or heart issues? My BP runs just a little below norm. Cholesterol is under control, with diet. Heart attack risk is under a full point of avg. I’ve passed my stress test.
Medicare/Tricare Life make no exceptions! Rationed health care, that gets less each year under 0’care.
I had no health ins for years, and ins when I was younger is not what we have become spoiled too. Nor was it much when I entered the work force.
No lump should go with out at least a needle biopsy.
I lost my step dad to lung cancer discovered to late, even though he was getting lung xrays every 3 months.
I have the back from H, and no 2 MRI’s have every read the same I’ve had quite a few. U get one every time they do a nerve block, which don’t work worth a hoot.
From what I understand non genetic has a higher rate than genetic does. Same goes for blacks they are more prone to BC.
Obamacare is about not paying for care so of course they want women to back off getting care.
I don't know. That sounds like too many x rays and tests. But, maybe your doctor is worried about the hypothyroidism possibly causing heart damage.
According to what the genetics counselors told me, anyone who has the mutation can pass it on. But, it can't be passed on by someone who doesn't have it.
The study is from canada . They have socialized medicine . Rationing .
I thank The Lord I had my mammograms yearly , only wish my mother had .
It shows that a regular physical examination will result in just as low a mortality rate.
No “ physical exam “ would have found mine .
What is your point?
Get a mammogram .
The outcome will be the same either way.
Nope .
Whatever.
Just keeping it real. People should make their own healthcare decisions absent government intervention and/or coercion.
That depends - every case is different. I didn't have a mammogram, and I found the lump myself - already stage two. It's possible the mammogram wouldn't have caught it, but I often wonder: Suppose it had?
Soon afterward, one of my relatives had a mammogram, and the cancer was caught at Stage 0.
Jwalsh07 found a link to a report on flaws in this study. See post # 78 above.
I saw that and clicked on the link. The font made it unreadable. I have also read that it was a very good study, 25 years long, 900+ subjects. The fact that it was done in Canada is meaningless. The fact that Canada has socialized medicine is meaningless.
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