The Lies And Truths Of Mammography
20 Nov 2009
Never before have women been more confused about breast mammography. A U.S panel of experts now reports that women under 40 years of age do not need mammograms, and those over 50 require them only every two years. So here are eight points women should know about mammography.
One – During this debate no expert has mentioned one vital fact. Mammography is a "lump" diagnosis. This means that years have gone by before a cancer lump is large enough to be detected by X-rays. This provides time for a malignancy to spread. I’ve stressed for years it’s a lie to tell women mammography diagnoses early cancer. It does not. Rather it diagnoses breast cancer as early as it can be diagnosed. This is why so many women die from breast cancer in spite of regular mammography. Contrast this to the Pap smear that detects abnormal cells (not lumps), in the cervix which can be destroyed years before they develop into cancer.
Two – The cruel truth is that whatever way you slice the cake the decrease in cancer deaths because of mammography is modest. Experts agree that 2,000 women must be screened for 10 years to get one benefit. You can always argue that saving one life makes it worthwhile. Others would argue that our health care system can’t afford to fund 20,000 mammograms for one life. Or, that this money should have been used to find a more accurate way to diagnose breast cancer. Even the American Cancer Society has stated that the value of mammography has been overstated.
Three – For years a huge effort has been to show women the benefits of mammography with little effort to point out several side effects of this procedure. All too often I’ve seen the profound anxiety of patients when a report states that additional X-rays must be taken due to a questionable first result. Then real fear sets in when a second report is still unable to separate a cancerous mass from a benign one. More sleepless night follow during the wait to have a breast biopsy and further delay for the report. Women’s College Hospital in Toronto can now make the diagnosis of breast cancer in one day. Hopefully, others centers of this kind will soon be available.
Four – One study showed that women who have regular mammograms over a 10 year period have a 49 percent chance of requiring a breast biopsy during that time. These are tough odds to face, much worse than those at Las Vegas.
Five – Most women breath a sigh of relief when their mammogram is reported normal. What they fail to realize is that at any age, mammography may fail to detect an existing malignancy. For instance, in women 40 to 49 years of age mammography misses 30 percent of malignancies. The end result is a false sense of security.
Six – Mammography proponents like to glide over radiation exposure received during mammography. But, if mammograms are started at age 40, women receive over 30 exposures to radiation by age 70. Possibly more, as during this time questionable reports will require additional X-ray exposures. Some international experts are concerned that excessive radiation from mammograms may cause malignant change. But there’s no evidence to prove this happens.
Seven – Don’t forget the emotional aspect of this debate. Many women’s groups claim that any attack on the benefits of mammography is like damning Motherhood and apple pie. Nor should one forget that vested interests usually favour mammography, as it’s good business for radiologists, surgeons and vendors of this medical equipment.
Eight – The best solution to the mammography dilemma is for women to discuss the pros and cons of mammography with their doctors. At the moment for women at high risk of breast cancer, mammography cannot be discounted. For others, the question remains whether the small advantage of mammography outweighs the potential radiation hazard and worry so often associated with this procedure. Unfortunately, until we have a better test to diagnose breast cancer no one has the ultimate answer. This debate requires the wisdom of Solomon.
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