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Confusing Value of Mammograms

Posted 7/15/2014

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  If you have been paying attention over the past few years, you are aware that there has been a great deal of study, discussion, and controversy about the value of mammograms. An important reminder: all of this is related to screening mammograms, and that means looking for breast cancers in healthy women. Those of us who have had breast cancer or women who have a palpable lump receive diagnostic mammograms; that is a different conversation.

  Many women who have had breast cancer that was discovered by a mammogram passionately support their importance. When you believe that this test may have saved your life, of course it seems vital! Most of the research, however, when carefully read suggests that mammograms do improve survival, but not mortality, in women ages 40-59. What is the difference? Survival means how long you live, and mortality means death. In this case, this translates to this kind of scenario: A mammogram detects a small breast cancer in a 45 year old woman. She has surgery, other necessary treatment, but the breast cancer recurs and she eventually dies of the disease at age 51. If she had not had the mammogram and the breast cancer had been discovered on physical exam when she was 47, she would have been treated then, and might still have died at 51. Conclusion for her: her survival after a cancer diagnosis was counted as 6 years with a mammogram and only 4 years without that exam. Ergo, survival is increased, but mortality is not changed.

  Here is an excellent essay from The Atlantic that further explores this topic. I give you the start and a link:

How Mammograms Improve Survival but Not Mortality
By James Hamblin

About 16 million breast x-rays (mammograms) are done every year in the U.S. in attempt to stem the
41,000 annual lives lost to breast cancer. A large, long-term study came out late yesterday in a major
medical journal, BMJ, that says mammography may be a waste of time and money.
The actual study says that screening for cancer with mammography in women ages 40 to 59 "does not
reduce mortality from breast cancer" in places where treatment is available.
The University of Toronto study split a group of 89,835 women in two. Half of them got mammograms,
and half did not. After 25 years, the rate of death from breast cancer was the same in both groups.
Some of the women who underwent mammograms ended up with unnecessary treatment.
The research is well done and will influence a global conversation. Dr. Richard Wender, chief of cancer
control for the American Cancer Society, said an expert panel will factor this research into new
guidelines to be released within the year. Until then, current recommendations stand.


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