The Choice of a Mammogram in Your Wellness Quest

I’m so Confused!

Should I get a mammogram or not???? The answer is that most unsatisfying, “it depends”. In a post I wrote one year ago, I said:

Perhaps the best thing the USPSTF has done for us is to uncover the ugly truth. The fact is we don't have any very good tests for early diagnosis of breast cancer. Mammograms and breast exams have subjected us to many unnecessary biopsies. These have harms--physical, psychological and economic.

I stand by that statement even in light of the new research from the Swedish study that showed women that have screening mammograms between the ages of 40 and 49 have a decrease risk of death from breast cancer. However, in order to save one life from breast cancer, 1252 women had to undergo mammography. We don't know what happened with those 1252 women. Did they have complications from unnecessary biopsies? Did any of them die from the medical interventions involved? We know that accessing the healthcare system has its hazards. Take a look at information about this topic at the Project Patient Care website. The harms of any medical intervention must be taken into account in assessing the ultimate value of that intervention.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, similarly points out a flaw in the way that the Swedish study was done: researchers did not take into account overdiagnosis. He tells us that about 15 to 20 percent of localized breast cancers will not spread and don't actually need treatment.

This is no minor thing. Let me tell you about my son who called me from college the other day with a sore throat. (Of course there’s no thermometer within a mile or two.) I knew what was coming…Mom…can you call me in a prescription for antibiotics? This would be the point at which he would report his diligent studying for finals and how going to the student health center could cost him a lower grade in accounting. My answer was still…no…you need to go to the clinic at school.

I told him the story of a patient I saw some years ago. She was a college student with the same complaint as my son, a sore throat. As it was finals week, her mother helpfully mailed a leftover bottle of antibiotics to her to save her the time of going to the school clinic. She took a few doses and felt better, until the diarrhea kicked in. The long and short of it is that this young lady developed a very severe form of clostridium difficile diarrhea. So bad that she came close to losing her colon to the disease. Compare the long term dependence on a colostomy bag to a “B” or even a “C” on the sophomore accounting final. My heart went out to her mother who was saddled with guilt and remorse for her attempts to help her daughter out.

So medical care must be applied judiciously. Like antibiotics, mammograms carry risk. There's radiation exposure and you might get an unnecessary biopsy or even chemotherapy. And you may never know whether or not these were necessary. So we need to aggregate all those experiences and turn them into “data”. Then use that data to see how our miracle technologies have helped AND harmed people.

Don’t get me wrong, mammograms and many other technologies do save lives, improve quality of life and lengthen life. And we want to use them wisely so as to offer the maximal benefit with the least harm. In my opinion, these two studies don’t (yet) change the USPSTF conclusions. So as you take ownership of your personal health, be informed, talk with your doctor and rely more on good information and less so on fear in your decision to proceed with or delay a mammogram.