So annual mammography does not cut breast cancer deaths. This, according to a 25-year Canadian study published this week on bmj.com. The study also concludes that almost one-quarter of screen detected breast cancers were over-diagnosed, meaning that these particular breast cancers would not cause death in that woman's lifetime.
So the study makes me wonder: Do you still believe in mammography?
I don't know about you, but studies like this do not make me feel confident about my healthcare. Am I supposed to not have a mammogram because research is telling me that if it finds a cancer I might still die from the disease? Just how much should I worry about over-diagnosis when, in this day and age, the actual science of distinguishing a lethal cancer from one that may not progress to much is not yet perfect?
I know that mammograms are also not perfect. They may miss some cancers, and some that are found may not progress to the point where they threaten my life. But numerous studies have shown that mammography does save lives. And I have been told repeatedly by breast cancer physicians and researchers that it is metastatic breast cancer that is the worry, not the breast cancer that has been found in early stages before it has spread.
So I will still have a mammogram every year or two, in the hope that if a breast cancer is found it is found earlier than later and before it has metastasized. I will still have that mammogram even though we now have better breast cancer treatment (more drugs, including anti-estrogen therapies) to treat breast cancer at any stage; according to this study, patients who were diagnosed early with mammography and later with no mammography had similar outcomes.
I will still have a mammogram, even though this study also noted that just as many cancers were found by physical exam as by mammogram. I want both. From what I know, physical exams, though they sound easy, are difficult to do well. In a breast clinic where health care providers are highly trained, and where breasts are being examined throughout the day, I can be confident that small lumps and irregularities will be found. But would the same be true in your average physician's office?
The latest report from the World Health Organization's Agency for Research on Cancer says that cancer deaths rose to 8.2 million in 2012 and that one of the cancers shown to have sharply increased is breast, particularly in developing nations. Is this the time, then, to cut back on mammography? I fear that decisions to cut mammography may be about money: Mammography screening is expensive, yes, but so is treating women for whom the cancer was found at a much later stage.
Let me have the mammogram, and let me decide how I want to proceed if you say the cancer you detect won't bother me in my lifetime. This is the argument used in prostate cancer: This particular cancer will likely outlive you in that you will likely die of something else. Maybe I still want to have it removed or radiated, even if my breast cancer is small. Let me decide in partnership with my doctor.
I will continue to have mammograms even though there may be false positive results. I have trouble with the issue of false-positive mammography results "harming" women, as many studies claim. False-positives are a part of today's world of scans and screens and the solution is not to avoid these tests because of the potential stress or treatment they may cause.
I had a callback for a mammogram when a spot was detected. Yes, I was upset and nervous when it was suggested that i have a follow-up core biopsy done. But the jittery nerves were worth it in that it was discovered there was nothing to worry about. If the spot had been a breast cancer, no matter what the eventual outcome, I would have been grateful for the early detection.
The Canadian Association of Radiologists recommends that, starting at 40, all women should speak to their physicians about beginning regular breast screening. I think that is good advice, and I cannot imagine any family physician who would tell her patient, after reading this recent study, that as there is no evidence that mammography saves lives why even bother.
Just three months ago, the Canadian Breast Cancer Foundation completed a massive Pink Tour to increase breast cancer awareness to over 21,000 Ontario women. "We want as many Ontarians as possible to know that one third of breast cancers are preventable and that regular screening saves lives," CEO Sandra Palmaro wrote on their website at cbcf.org. Now that this study questions the benefits of routine mammography, what will breast cancer organizations tell their supporters?
I noticed that The American College of Radiology and Society of Breast Imaging called the study "misleading" and urged that its findings should not guide policy on breast cancer screening. To do so, the group said in a statement, "would place a great many women at increased risk of dying unnecessarily from breast cancer."
I will still have a mammogram even though we are clearly in an era that is over-focused on over-diagnosis. Said the study's researcher, Dr Anthony Miller, professor emeritus at the University of Toronto: "The majority of breast cancers are detectable by mammography, but whether or not this is beneficial has now become very controversial." I dunno. The fact that the majority of breast cancers are detectable by mammography is good enough for me. Call me old-fashioned, but let's not throw out the baby with the bathwater.
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