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Value of Mammograms Questioned Again

Posted 2/12/2014

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  Before I launch into today's important news, I want to say that this is the last blog for a couple of weeks. Assuming that the weather does not prevent our flight to Tokyo from departing tomorrow, my husband and I are leaving for two and a half weeks in Burma and Cambodia. We are very excited! I have lived in Southeast Asia, and we have traveled there together in the past, but these will be new experiences. Plus, there will be no snow or ice or bitter cold winds; actually, it will be in the high 90s and very humid, and that is not so great either. I will  have intermittent email access, but am not taking a computer, and am going to try to take a vacation. So, back on line here on March 2nd or 3rd.

  The big news in Breast Cancer World today is a vast Canadian study, published in The British Medical Journal, that again questions the value of screening mammograms in saving lives. (remember that screening mammograms refer to the general population of women, not to us)

  This study is all over the news, so there are articles wherever you look. Here is a quote from The New York Times article; in includes a link to the journal article, and you may want to read the real thing. Following this excerpt, I am going to share a reaction from one of our radiologists.

Vast Study Casts Doubts on Value of Mammograms
By GINA KOLATA FEB. 11, 2014
One of the largest and most meticulous studies of mammography ever done, involving 90,000 women and
lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of
any age.
It found that the death rates from breast cancer and from all causes were the same in women who got
mammograms and those who did not. And the screening had harms: One in five cancers found with
mammography and treated was not a threat to the woman’s health and did not need treatment such as
chemotherapy, surgery or radiation.
The study, published Tuesday in The British Medical Journal, is one of the few rigorous evaluations of
mammograms conducted in the modern era of more effective breast cancer treatments. It randomly assigned
Canadian women to have regular mammograms and breast exams by trained nurses or to have breast exams
Researchers sought to determine whether there was any advantage to finding breast cancers when they
were too small to feel. The answer is no, the researchers report.

And some of our doctor's thoughts:

Their conclusion in the abstract states “annual mammography did not reduce mortality from breast cancer compared to physical exam” BUT when review the paper itself, one will see that 68.2% of the cancers in the mammography arm were palpable and 30.6% cancers in the mammography arm node positive. Of the 666 cancers detected in the mammography arm 176 (26.7%) were interval cancers. One has to question the quality of their mammograms and what they call a ‘screening’ program.

They admit in the paper that the difference in survival after a diagnosis of breast cancer was significant between those cancers diagnosed by mammography alone and those diagnosed by physical exam screening but state “this is due to lead time, length time bias and over-diagnosis.” Later they add “cancers detected in the mammography arm were significantly smaller than cancers detected in the control arm, and the 25 year survival of women with breast cancer diagnosed in the mammography arm was superior to that of women with a diagnosis is the control arm.”


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