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.
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?