Good reasons to keep the mammogram debate going

Last month’s reports on the Canadian mammogram study set off a heated debate. And not just among my Daily Dispatch readers. The debate continues to rage throughout the mainstream press. Some critics pick apart the study. Some experts praise it.

And I wouldn’t want it any other way.

The way I see it, debate is a good thing in medicine. Especially when it comes to cancer screenings and treatments. It means people are talking about and participating in their health decisions. And I can only hope that it will lead to more discovery. And bring some much-needed science to the debate.

So today, we’ll keep the debate going. And I’ll share one thoughtful reader’s story. She wrote:

I am living proof that mammograms DO SAVE LIVES. In April 2006, I was diagnosed with early stage breast cancer after having a mammogram. The tumor was too small to be felt in a normal breast exam. Had I not had the mammogram in 2006, the tumor would have grown much larger, and I may have lost my breast to surgery. I only had a lumpectomy and 33 sessions of radiation in 2006. I used humor to accompany me on my journey, and I crocheted butterflies and gave them to doctors/nurses/other patients. I laughed and joked a lot. It’s my way of dealing with stress. I healed quickly due to a positive attitude and sense of humor. I will celebrate my 8th year as a breast cancer survivor on May 9, 2014. Please don’t discourage women from having a mammogram. They DO SAVE LIVES!
First of all, I’d like to thank this reader for sharing her experience. And extend my congratulations. Her positive attitude surely contributed greatly to her conquering breast cancer.

I also want to make a few additional points on the issue of mammograms.

In February’s Daily Dispatch, and my others on this topic, I made it clear that each woman should be treated as an individual. And you should always consult with your physician about the approach that feels right for you.

In addition, your age is an important consideration. The statistics about detection and survival rates vary greatly among younger, middle-aged, and older women. But always remember, statistics are only about populations. And they provide potentially useful guidelines for public health screening programs–if actually used wisely.

As another Dispatch reader aptly pointed out, “statistics mean nothing to the individual.” And she is right. Indeed, your personal situation outweighs any statistical model. So here again, consulting with a trusted women’s health physician is important. And ultimately, you must make a decision that feels right for you.

I carefully studied the issues of breast cancer screening as part of the largest study that had ever been done to that date by the National Cancer Institute back in the 1980s. It was called the Breast Cancer Detection Demonstration Project.

Even back then, before we knew more about mammograms’ shortcomings, we felt it was very complicated and controversial to determine the optimal screening ages, frequencies, and intervals for this test. And then, when you apply those standards to every woman in the United States, how do you measure success?

I believe we should measure success when cancer death rates in the whole population decline. (That is the only way to get around the problems of false positives, over-diagnosis and overtreatment that we have repeatedly documented for breast cancer screening. As well as for colon cancer, prostate cancer, skin cancer and others.) And mammograms fail to bring this number down any better than physical exams among younger to middle-aged women.

According to the study’s lead authors, “Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.”

Nevertheless, every woman (and man) is an individual. And should be evaluated as such. I always encourage you to consult your physician regarding personal health matters. Hopefully, your physician treats you as an individual. And not just as a statistic.

I’d like to see the cancer industry explore other screening tools for breast cancer. One reader mentioned breast thermography to me. And that is indeed a viable option. I first became aware of breast thermography from a physician friend and colleague at Harvard-Massachusetts General Hospital almost 40 years ago.

Unfortunately, despite its potential advantages, it hasn’t caught on among the mainstream cancer establishment. However, you can do your own investigations. Consult with your physician about where and how to get thermography in your area.

And thank you to all my passionate and informed Daily Dispatch readers who reached out to me about this important topic. Keep the comments coming on my website and Facebook!

Sources:

  1. British Medical Journal, published on-Line, 2/11/2014
  2. “Annual Screening Does Not Reduce Death from Breast Cancer,” Medical News Today (www.medicalnewstoday.com) 2/12/2014

 


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