I came across this story this morning. It tells us that less than half America women attend their scheduled, recommended mammogram examinations. The article cites possible reasons for this short-fall in take-up, specifically “discomfort from the test, lack of available screening centers, general non-compliance or denial.” All of these have some validity, I suppose, but I think this list omits another likely underlying factor.
Through all the pro-mammography propaganda that women have been bombarded with for many years now, research has emerged which clearly shows two things:
1. Many, many women need to undergo mammography to save a single woman’s life. For example, in September research was published which indicated that to prevent one breast cancer death, 2500 women would need to have a mammogram.
2. There are considerable risks associated with this practice. In particular, women risk being diagnosed with and treated for cancers that would not have bothered them in the natural course of their lives. The research I wrote about in September also revealed that of 2500 women getting a mammogram, maybe 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.
Now, up until relatively recently the ineffectiveness of mammography and the very real hazards associated with it were, essentially, untold. As a result, literally millions of women were not given access to the information they require to make truly informed decisions about whether or not to have a mammogram.
All that has changed now, and principally because of the internet. While many doctors, charities and our Governments still seem reticent to tell the truth about mammography, any woman with internet access can now learn the other side of the story regarding this practice.
My suspicion is, therefore, that many women who do not attend their scheduled mammography appointments do so because they have weighed up the evidence and decided that it’s just not for them.
This is a serious issue. About fifteen years ago, my wife was scheduled for a mammogram. Privately, I had my doubts about this procedure, suspecting that it caused more trouble than it detected. However, I kept my mouth shut.
In due course my wife had the test, cancer was detected, and she underwent surgery, radiotherapy, chemotherapy, and five years of tamoxifen treatment (as I understand it this is a hormone). My wife’s cancer cells were said to be top-rated on the malignancy scale, so we have no regrets about these procedures, which probably saved her life.
However, I read recently that 95% of women who are treated for breast cancer end up sexually dysfunctional, and that is certainly true of my wife. As a result of the various treatments, her body has changed quite dramatically (over and above age changes) and she has gone from a person who could have an orgasm very easily to one who cannot achieve orgasm at all.
Women therefore need to be exceptionally well informed on this issue, and, when armed with appropriate information, they need to think very hard about what to do. Having treatment unnecessarily has serious implications — and not just in terms of cost and inconvenience.
After 5 years and deciding I would bypass the mammograph routine, I had a mammogram last month ONLY because I now have ovarian cancer and a recent CT/PET scan revealed something suspicious in right breast. After focusing mammograms on right breast, then calcifications were noticed in left breast. More images were taken, then sonogram/ultrasound. I lost count of the images taken. Bottom line, growth in right breast – ordinary cyst, left breast calcifications had been there at the last mammogram 5 years ago. Praise God there was no more cancer, and given the situation I felt more compelled to have everything checked. Unfortunately our insurance company and probably most others consider thermography unreliable and won’t cover it. It’s big business.
NNT – Number to Treat
You have drawn attention (again) to this most important numeric marker of whether or not to let oneself accept any treatment when it is proposed.
I myself use it as THE important factor.
I usually look for an NNT in the range 10 to 20 for accepting a treatment recommendation when “side effects” are nasty.
Keep up the good work.
Wondering whether you think that MRI will become the gold standard test and its mainly financial implications which are holding up up both the availability, research and experience of interpreting breast MRIs? Thanks.
I was diagnosed with early breast cancer in August 2010. I did not feel a lump, only a thickening in the breast which everyone, including the specialist, initially said was ‘entirely normal for a woman of my age’. I had an ultrasound and a tiny 5mm lesion was discovered, the next day this was confirmed by mammogram. I have had surgery, radiotherapy and am now taking tamoxifen for 2 years followed by 3 years of exemestane.
I too wonder whether such a tiny tumour would ever have amounted to anything significant. Had mammography not been available, would I ever have known about it? Would the cancer have grown or would my immune system have dealt with it? I shall never know.
What do you think about colonoscopies? My mother religiously had them, every year or more, eventual non cancerous polyps operated on and even so died of colon cancer. My aunt had a “preventative” operation for a polyp and got peritonitis from the operation and died. Both were over 80. Another brother of a friend got a punctured intestine from the exam.
Dr. Briffa,
I’m very curious about your opinion of annual colonoscopies for those over 50? It seems there is not a lot of research about how necessary this procedure really might be?
Spend more time being happy and “living” your life rather than searching for things that might be wrong with your bodies. People spend countless hours getting tests done worrying about results and looking for things wrong with them yet they eat rubbish like sugar and soy they smoke and drink and some even take life threatening drugs thinking they will help with the stress of living. talk about an insane way to live?? Cry Laugh and Play enjoy your lives and the people in them spend less time getting tests done all you are doing is proping up enconomic system based on the cure of diseases they dont’ want cured in the first place because it would cripple their profits
I have had three mammograms and after each one developed a nasty abscess which required antibiotic treatment. It took me 3 times to realise that it could be the mammograms causing it and a doctor confirmed that the test causes considerable trauma to breast tissue. So what other damage could it cause that isn’t so obvious I wonder? I was told (wrongly) that because of this I could have my breats scanned instead, but that is not an option I discovered, so now I just refuse to go.
I agree with you, Dr Briffa
More damning evidence emerged recently: it seems the fall in the death rate from breast cancer is about better treatments, and not screening.#
Prof Michael Baum, UK breast cancer surgeon, is calling for a halt to the program and is taking legal action (with others) against the NHS for failing to obtain informed consent from women.
The UK is fortunate to have many doctors and others fighting for informed consent in cervical and breast cancer screening. Australia has no high profile and vocal advocates for informed consent – there is no one protecting the rights and health of women in cancer screening – there is no respect for informed consent.
I’ve rejected breast cancer screening on the basis of information that is not released to women.
All women should have the opportunity to make informed decisions about screening, but that has never happened…IMO, these programs go out of their way to conceal risk and inflate benefits. The focus is on govt-set targets and protecting the programs and vested and political interests.
I found the summary prepared by the Nordic Cochrane Institute very helpful – “The risks and benefits of mammograms” is at their website. Sadly, most women won’t see it…
Prof Baum’s latest lecture at UCL is also excellent, “Breast cancer screening: the inconvenient truths” on Utube.
#http://www.guardian.co.uk/commentisfree/2011/aug/02/breast-cancer-screening?INTCMP=SRCH
(the link to the BMJ is in comment 3 or 4)
How is thermography rated versus mammography. Until what age should a woman undergo either?
After all, Pap smears are terminated at age 70 unless there is cause for continuation.