Women again not given the full facts about mammography

Mammography involves taking X-rays of the breast, in an effort to detect breast cancer earlier, with the hope that treatment will be more effective. It’s an approach that appears to make eminent sense. Yet, objective study of mammography shows that it doesn’t work so well. For a start, many, many women have to undergo screening for one to have her life saved due to early detection. Plus, mammography leads to a lot of women having further investigations and treatment for harmless lumps and even bona fide cancer that would not have bothered them if it were left alone.

In September, I wrote about some recent evidence which asked serious questions about the effectiveness of mammography, as well as the problems of over-investigation and over-treatment. Here’s an extract from this blog post.

If 2,500 women aged 50 were screened with mammography, only ONE will avoid dying of breast cancer. Now, many of these women (as many as 1000) will have to endure the potential stress of being told by their doctors that there’s something suspicious on their mammogram. And about 500 of these will go on to have a biopsy – an invasive procedure around which there is usually considerable anxiety. As a result of biopsy, it is estimated that between 5 and 15 women will be treated unnecessarily for a condition that was never going to bother them.

This week saw the publication of a study which argues for extension of the mammography programme here in the UK [1]. Currently, women aged 50-70 are invited for mammography every three years. But the study in question argues that it should be offered to women aged 40-49 deemed to be at moderate or high risk of breast cancer because of a positive family history of this condition.

This study has received widespread coverage, and almost all of it has been very positive. See here for an example. You’ll see here that the lead investigator of the study, Professor Stephen Duffy, estimates that extending screening to these women in the form of annual mammograms would save about 50 livers a year. But according to the article, about 300,000 women would be eligible for this screening. Let’s do some maths. If 300,000 women need to be screened each year to save 50 lives, then 6000 women need to be screened to save one life.

I’m not glib about any life saved. But even the most enthusiastic promoter of mammography would surely have to concede that these figures indicate a poor return on investment. The obvious question is if the money and resources pumped into mammography might be better spent elsewhere.

Read the article that I’ve linked to and you’ll see that Professor Duffy claims that extending mammography would give many women peace of mind. That might be true. But what is not mentioned here is the fact that, for many women, having mammography and waiting for the result is inherently stressful. And, as is often the case with those who vigorously promote mammography, no balance is given by reference to the women who have unnecessary biopsies or other investigations. And no mention is made, either, of those women who would end up undergoing potentially devastating treatment for something that would never have brought significant harm to them if left alone.

This morning at breakfast I was having a conversation with a friend and colleague about something unrelated to mammography: cholesterol. I was putting forward some of the counter-arguments to the idea that cholesterol causes heart disease and that reducing cholesterol is inherently beneficial to health. Some doctors seem to get very agitated to hear these opinions even expressed. I have sometimes asked such doctors why they have an issue with people hearing some of the contradictory evidence. Why should patients not hear the other side? The most common answer I get is that “it confuses them”. That may be the case, but that in my view is simply not a good enough reason not to tell people the truth. And in reality, I don’t think patients are as easily confused as many doctors think. For instance, after hearing the contradictory evidence regarding the cholesterol hypothesis, practically everyone I’ve ever met appears to be in no doubt about how seriously they should take their ‘elevated’ cholesterol.

When, in medicine, we only present one side of the story, we rob our patients of the ability to make truly informed decisions about their treatment, and I think this is inherently wrong. I’m obviously never going to have mammography myself, but I do believe that women have the right to know all the facts about this procedure. Listen to people like Professor Duffy and you’d imagine that women who refuse mammography have taken leave of their senses. But as the research I wrote about in September demonstrates, many women would decline mammography end up be significantly better off.

References:

FH01 collaborative teams. Mammographic surveillance in women younger than 50 years who have a family history of breast cancer: tumour characteristics and projected effect on mortality in the prospective, single-arm, FH01 study. The Lancet Oncology 18 November 2010 [epub ahead of print]

12 Responses to Women again not given the full facts about mammography

  1. Ruth Brown 19 November 2010 at 2:56 pm #

    I totally agree with this. I stopped having mammograms because I just can’t believe that something so incredibly painful, plus the xrays themselves can be anything but traumatic.

  2. Free Forester 19 November 2010 at 4:09 pm #

    I have had repeated disagreements with a friend about mammography. She does indeed think that anyone who does not have the screening is crazy, and it has affected our friendship! She refuses to read anything longer than one paragraph about either medicine or politics. Oh dear.

  3. Jane Laine 19 November 2010 at 5:38 pm #

    What about ultrasound, would that not give more accurate results?

  4. Mauris Emeka 19 November 2010 at 6:20 pm #

    I agree completely that mammography is very very risky business, and that all in all it contributes to the problem more than solving it.

    I wish, however, that we all (including the writers of this blog) would start referring to malignant or cancerous tumors for what they really are,namely, SYMPTOMS of cancer ane NOT as ‘the cancer’. In truth the tumor is a symptom or indication that an unwanted process has begun within the body– a process that obviously needs to be halted. The tumor symptom and the underlying PROCESS that begets the tumor are NOT the same. Therefore,referring to the tumor as ‘the cancer’ is a bit like calling smoke that rises from a fire ‘the fire’– when in truth the smoke is an indication (or symptom) of a fire. Our focus really needs to be more on the CAUSE (i.e. the body’s malfunctioning PROCESS) than on the EFFECT (i.e the tumor symptom). By making this fundamental shift in how we perceive cancer, it puts the arguments for and against mammography in truer perspective.

  5. Mauris Emeka 19 November 2010 at 6:22 pm #

    I agree completely that mammography is very very risky business, and that all in all it contributes to the problem more than solving it.

    I wish, however, that we all (including the writers of this blog) would start referring to malignant or cancerous tumors for what they really are,namely, SYMPTOMS of cancer ane NOT as ‘the cancer’. In truth the tumor is a symptom or indication that an unwanted process has begun within the body– a process that obviously needs to be halted. The tumor symptom and the underlying PROCESS that begets the tumor are NOT the same. Therefore,referring to the tumor as ‘the cancer’ is a bit like calling smoke that rises from a fire ‘the fire’– when in truth the smoke is an indication (or symptom) of a fire. Our focus really needs to be more on the CAUSE (i.e. the body’s malfunctioning PROCESS) than on the EFFECT (i.e the tumor symptom). By making this fundamental shift in how we perceive cancer, it puts the arguments for and against mammography in truer perspective.

    19 November 2010 @ 6:20 pm

  6. blackdog 19 November 2010 at 6:53 pm #

    Plus don’t forget the high radiation dose recieved, which is about 1000x (yes I do mean that) of a standard chest X-Ray.
    Ionising radiation in it’s own right, is a well known source of cancer and being sent for a retest as well as being terribly traumatic, leads to yet another screening at the same rate. I conclude that in that circumstance, the dose would exceed that for a non classified person.
    Also for a standard two view screening, you would have to reduce the absolute risk of cancer for a 40 yr old by 10% for it to be of any benefit at all.

  7. Nathalie Dommett 19 November 2010 at 7:08 pm #

    Let’s put aside the unnecessary anxiety (pre and post test) and the “shame” mammograms cause, they are also very painful (as Ruth mentions above). What about the increased risk of cancer from biopsies and repeated x-rays?

    Read this article from Suzanne Sommers Blog: I like the paragraph about putting men’s privates into a “panini” type of machine and radiating them! :-)

    http://www.suzannesomers.com/Blog/post/Dr-Russell-Blaylock-on-Mammograms-and-Testiculograms.aspx

    So, why isn’t there a Government programme of “testiculograms”? Anyone?….

  8. Andre J Smith 19 November 2010 at 8:34 pm #

    Early detection of 1 in 50 tested sound like on heck of a good reason to be tested. For the 1 person found positive this could have been the most important thing in their life. Even if it is a 1 in a million chance I would still want to be empowered by knowledge. Recently I went for a barrage of tests simply to see if there was anything wrong that I had not picked up yet. Well, anaemia surfaced and i am glad to say that i am now being treated and am happy in the knowledge that I have few other ailments waiting to pounce on me. This same right action resulted in a good friend recently picking up her breast cancer via a routine scan. It turns out that the early detection may well save her life as it is a rather virulent form of cancer. So be it. if I have access to preventative medicine then I will use every last bit at my disposal to live longer and happier.

  9. Valerie H 19 November 2010 at 8:41 pm #

    I have read that thermography is another screening option but it detects different things than mamography.

  10. Victoria 20 November 2010 at 12:35 am #

    Jane Laine says:
    “What about ultrasound, would that not give more accurate results?”

    Not normally a coward, I was so dreading having the mammogram that I was due to have a couple of months ago after the horrendous pain of the last one that I asked my GP if there was an alternative. She told me that ultrasound couldn’t pick up problems in the early stages with the same accuracy as a mammogram and suggested I talk to the person carrying out the x-ray beforehand. I did this and she was extra specially careful and it was OK-ish. Now I’ve been given the all-clear I feel good about it, but that obviously wouldn’t be the case if the mammogram had picked something up.

    It’s a tough call. But the question I have is how do you distinguish between a cancer that could prove fatal to someone and one that “would never have brought significant harm to them if left alone”? Is it possible for a problem to be identified by a mammogram, assessed as not life-threatening and then left alone?

  11. Eliz52 (Aust) 19 May 2011 at 12:30 pm #

    I’d urge every woman thinking about having mammograms to listen to the 35 minute lecture by UK breast cancer surgeon, Prof Michael Baum on the Medphyzz site – recorded at UCL recently and called, “Breast cancer screening: the inconvenient truths”.
    Also, the Nordic Cochrane Institute have produced “The risks and benefits of mammograms” – it’s at their website – produced because they were concerned at the misleading and incomplete nature of the screening brochures.
    How do they get away with misleading and harming women – are we third class citizens with no rights?
    I’ve declined mammograms and CBE’s are not recommended here, they don’t help, but cause biopsies. I practice “breast awareness” devised by the late Dr Joan Austoker – simply taking note of the look and shape of your breasts in the mirror every morning after showering. Breast self-exams have been out for years…they don’t help, but lead to excess biopsies – not a good idea.

  12. Carolyn 30 October 2011 at 2:42 am #

    I am 45 and I have never had one, I refuse! I dont want to have somebody groping me for a free “feel”, and I find the whole test disgusting and I was always taught that someone groping you was a mortal sin. And yes, I was molested as a child, and every guy I have ever dated always “groped” me whenever and however they wanted. Yes, I still have issues with that! After I lost my job in 09, I moved out of state and in with a relative. I went to a low-no income clinic for a refill on some meds, and the doctor was a real jerk to me. He really treated me like crap to begin with. I told him several times I had NO funds, and that he cant force me to take that stupid test! We got in a HUGE argument about that stupid test, and just WHY I refused to get one. I was so upset that I left that clinic in tears and I was shaking from all the flashbacks of being groped, etc, and being reminded that it was dirty. I had to take a Klonipin when I got home. I couldn’t even drive home, I had to have a friend drive me home. I spent the rest of the next few days still very upset and crying cause that so called Dr.Spencer insisted that I have this done. I told him NO and thought that the argument should have clued him in that I was in fact NOT going to get it done! I thought that would be the end of it. Well, much to my surprise, 3 weeks later, I get this phone call from the mammo dept at the hospital. Turned out that jerk scheduled it anyway behind my back and without my consent or knowledge that he was going to schedule it anyway. I found that to be pretty dishonest! Then I asked the nurse what the cost was. She said it was 50 dollars!! Did I mention that I said “AND is Dr Spencer going to pay for it?” The nurse was speechless, and told me that since I had NO insurance and NO job, and NO income that I would have to pay for it. My response was “Yah, right!” and… “Just where was I supposed to come up with that kind of money since I just lost my job, NO insurance, and NO income?” I had just recieved food stamps. I am still very pissed off about that Dr Spencer treating me like crap then pulling some underhanded trick like this. I don’t want them or anyone touching me! Wouldn’t it just be cheaper if they just cut them off and be done with the whole mess? Now that I could go for, then all my shirts would look better instead of 2 fat useless lumps of boobs! YUCK!!! Dont let the medical community trick you into thinking you need to have this stupid test done! My health is just fine by the way! Stupid man Dr. How about him having his testicles squeezed in that same machine, then I can gaurantee you that they wouldn’t make women do this if they knew how it felt! Its all about the drug and x ray companies making money. Dont fall for it. If ya get cancer, then ya get cancer. Deal with it and realise that your time is up!

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