An Oversold Weapon Against Breast Cancer

Townhall.com ^ | February 16, 2014 | Steve Chapman

[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.

[Tired of Taxes]

Ok, well, the report at the link points out that the study relied on poor-quality, secondhand machines and the technicians weren’t trained properly.

So, assuming the report is true, then this Canadian study just tells us what happens when poor-quality, secondhand machines and poorly-trained technicians are used.

Believe me, I’d like to believe the study. Then I’d feel much better about my decision not to have a mammo. :-( Yes, there are many cases in which the mammo doesn’t catch anything. I might’ve been one of those cases, if I had one earlier, but who knows...

[Jim from C-Town]

No I don’t think Medicare Or Tricare or even the best policy from any health insurer would cover a MRI or even a CT with Die Resolution without having a positive Mammogram first. That is the point.

The other point is that regardless of how painful a single person, or even group of people, might find a standard medical procedure, they will not comply for those individuals when the idea of the test is preventative. Particularly when a Mammogram is both effective and cheap when compared to a CT at three times the cost and an MRI at ten times the cost.

Point three, mammograms save women’s lives. I know for a fact. A mammogram saved my wife’s life or at least saved her a much worse fight to remain alive. Get one, don’t get one, it is your choice. But for a study funded and conducted by a government, Canada, that pays for its’ citizens health care to say that they do not is a dubious study at best, particularly when a virtual unanimous opinion of oncologists and medical professionals say to get them yearly starting at age forty.