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Mammography, Sorting Out the Confusion, Part 2

In my previous post, I tried to navigate my way through the topic of mammography and the debate surrounding it by sharing some of my personal experience with mammography, an anecdotal account. Though anecdotal accounts are interesting and perhaps even useful, they are not based on scientific evidence or scientific anything.

So what is the science saying about mammography these days?

And why is there still so much confusion surrounding mammography?

Maybe it’s not the science part that is so terribly confusing at this point; maybe it’s the “what do we do now?” part that is.

It’s time to face the facts, but what the heck are they?

Well, for starters here are a few facts I’ve chosen to highlight and yes, I’ve over-simplified, but perhaps sometimes we make things too complicated. I’m trying to simplify in order to enable my mind to more easily sort this all out, and in doing so, I hope it helps you as well. I really wanted to add comments to each of the following, but decided to keep my opinions out. I am aiming to stick to the facts here. Also, I am definitely NOT suggesting anyone should not get a mammogram.

I don’t think any of the following are debatable, but feel free to let me know your thoughts…

1.  Mammography is far from perfect, largely because it’s old technology and there are many variables such as a woman’s age and breast density.

2.  Screening mammography is not the same as diagnostic. The debate focuses on the screening type.

3.  Screening is not prevention. A mammogram does not prevent cancer.

4.  Large numbers of women need to be screened to diagnose one cancer.

5.  Some women will receive false positives (false negatives happen too) and need to have additional imaging and/or biopsies.

6.  Due to improved imaging, we are diagnosing/over-diagnosing (and treating/over-treating) cancers that may never be a threat to a woman’s life.

7.  At this point in time, we cannot determine which cancers may never be harmful. Cancer/cell biology is unpredictable, and so we must over-treat some women.

8.  Still, this over-treatment is a big deal. It matters because cancer treatment has a cost factor, and I don’t mean just of the dollar kind. Slash, burn and poison do  not happen without collateral damage. They sound bad because they are bad.

9.  The benefits of mammography have been, and continue to be over-rated.

10.  For years major players (Susan G. Komen for instance) have pushed the screening/early detection message, which is not a complete message.

11.  There are potential risks of screening that too often have not been discussed or fully disclosed, again by major players, physicians and many others as well, of course.

12.  We are spending billions of dollars on screening, but the number of deaths to metastatic breast cancer is not really changing that much.

13.  Breast density matters regarding mammography accuracy, as does where screening is being done and who is interpreting results. Again, mammography is an imperfect tool.

14.  Women under age 40 with no family history are sort of left out in the cold with no good routine screening options.

15.  If you are brca+, or even if you’re not but there is obviously hereditary cancer risk in your family, none of this really pertains to you. For women at high risk, screening and surveillance is another whole ballgame. The debate is mostly about screening for the woman at average risk, meaning no family history.

16. The bottom line is we need better screening options and we need these better tools available at a reasonable cost and for ALL women – enough with the disparity! (Sorry, couldn’t help putting a little opinion in there). We need research to develop these better screening tools.

But, while we wait for those better screening tools, what’s a woman to do?

Yes, part 3 is coming…

As always, I welcome your opinions, but remember opinions are not necessarily facts.

What’s missing from this list?

Have you been feeling confused about mammography lately?

How was your cancer initially detected?

 

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image via cbsnews

 

 

 

11 thoughts to “Mammography, Sorting Out the Confusion, Part 2”

  1. This is an excellent post, Nancy. One of the things that bothers me is an aspect of the debate about false positives in screening mammography. Yes, false positives are a problem. But screening instruments are “screens” and give us guidance regarding whether further diagnostics are indicated. If a screening instrument has a high false negative rate, this is a much bigger problem.

    Anyway, the reason this bothers me is that it is often couched in terms of the negative impact of causing emotional distress to women. Of course it is upsetting to receive news that there might be something wrong and that more tests are needed. But I don’t hear this complaint about other medical screening techniques, just breast cancer, which primarily affects women. So the whole, “let’s not upset people” concern always strikes me as paternalistic.

    Am I the only one?

    -Elizabeth

    1. Elizabeth, I completely agree with the point you made about that emotional distress. I’ve always felt that was problematic too, so no, you are not the only one. Thanks for reading and commenting. Your point is an excellent one.

  2. Hi Nancy,
    This is an excellent list, and I think very comprehensive. A possible additional point might be that early detection isn’t only about mammography-that it’s important for women and men to be aware of changes in their breasts and get these checked out.

    For now, mammography is the screening tool we have but it does have lots of flaws. I wonder if years from now people will look back and marvel at how long this (rather primitive, it seems to me) approach remained in use.

    I agree with Elizabeth’s comment too by the way.

    1. Lisa, I think years from now people will indeed look back and marvel at many of our approaches such as removing a woman’s breasts. That sounds really horrible because it is. Some day people will be shaking their heads in disbelief. Thanks for reading and for making another important point. Although SEs are no longer recommended, this doesn’t mean a woman shouldn’t be familiar with her body so she can notice changes. Men, too, of course.

  3. Wonderful post, Nancy, and very comprehensive. I would add, as you said in your last comment, that SEs should still be done so a woman or man could become familiar with their bodies.

    I know SEs are not recommended, but I still don’t understand why. They can heighten fear, no doubt, but isn’t it important to know our own bodies?

    An SE saved my life.

    1. Beth, Considering your experience, it’s completely reasonable for you to be so strongly in favor of SEs. I guess the “proof” just isn’t there. Of course, this doesn’t mean we shouldn’t be familiar with our bodies, changes and all that. Thanks for sharing your perspectives, Beth.

  4. Hi Nancy,

    I was very confused about my mammography (and echography) results because nothing but microcalcifications were detected for 2 years in a row. However, they led to a Trucut biopsy which was the tool that discovered my DCIS.

    I was in turn scared of being over-treated–should I or should I not have my breast removed? I was tempted not to have anything done at all because of articles I read on the Internet, saying that only half of all cases of DCIS develop into cancer.

    Well, mine did. Therefore, I’m happy with the screening and happy that I followed the conventional approach.

  5. There is so much information out there regarding bc that it is hard to sift through the muck to get to the facts. Thank you for helping to better clarify the topic of mammography. Not only does it carry the risk of false +/- results, it doesn’t detect those breast cancers that don’t present as a lump (eg – inflammatory bc). One thing that confuses me also is that mammograms are recommended for “high risk” women/men (family history) but not those who do not carry any genetic risks. My understanding is that family history can be attributed to only about 10% of bc dx. Does that not make those without family history a high risk as they are the majority? I agree that mammography is not perfect but can be an important tool in the dx of bc (even though it did not detect my bc until after it had spread to liver). Being aware of ones body and advocating for ones self is just as important.

    1. Barb, There is a lot of information out there and yes, much of it can be confusing. As to your question, the simple answer is no. The general population of women (those without the hereditary risk) are not considered to be at high risk because there are more of them. The bottom line is that every woman needs to carefully consider all the information she can gather regarding her particular situation, discuss with her doctor about risk vs benefit and then choose to do (regarding mammograms) what seems to make most sense for her. Thank you for reading and sharing.

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