Buried among a spate of bad news announcements that the B.C. government released over the Christmas holidays was an update on a province-wide system for peer reviews of medical scans. The system was to have been operational by 2014, but still isn't in place at three of five health authorities and won't be until mid-2016 at the earliest.
"Mammograms save lives," read the headline from the Canadian Breast Cancer Foundation. My heart sank. Not only is this headline unlikely to be true, it's possibly dangerous. Recent research is adding up to what I would call a wholesale re-questioning of the need for mammography based on the fact that the overall benefits seem to be vanishingly small and the harms -- including unnecessary cancer scares, biopsies and surgeries -- considerable.
Unfortunately, our ability now to test for and find insignificant abnormalities in people often leads to medical interventions that offer little or no benefit but still carry all the potential harms. Harm as a consequence of necessary treatment can be accepted, but exposing healthy people to harm from treatment that they should not have had in the first place is unacceptable.
When first introduced four decades ago, breast cancer screening with mammography was widely regarded as an important tool in the fight against this terrible disease. It is now clear that the benefits of screening mammography have been greatly exaggerated and the serious adverse effects all but ignored in the enthusiasm to support breast screening programs. It's time for these programs to be reconsidered. This is a very unpleasant message for modern developed societies where three generations of women have been led to believe that regular mammograms will save their lives and where an enormous related industry has been built up, but it is time to face the facts.
So annual mammography does not cut breast cancer deaths. This, according to a 25-year Canadian study published this week. So the study makes me wonder: Do you still believe in mammography? 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.
On the day of my own yearly mammogram, a grumpy technician walks into the cold, dark room and begins, ever so nonchalantly, to wrestle one of my poor boobs into submission and I wince. Yet in spite of the wild indignation that having my breasts squished conjures up in me, I thank God for these technicians and radiologists because without them, we'd all be a lot worse off.
The news this week that the Canadian Task Force on Preventive Health Care is recommending that women under 50 do not receive mammograms and do not receive breast examinations as part of a regular physical examination just horrifies me. If that had been the "rule of the day" over 20 years ago, I would probably be dead now.
Let me try and boil down what the United States Preventive Services Task Force really is saying about PSA tests: Don't worry, be happy and oblivious. Because the treatment's after-effects can be rough. Don't worry, be happy, do nothing -- even though many of us know someone who has died young from prostate cancer.