Last Update: Wednesday, July 23, 2014
|Mammograms Still Warranted Despite Evidence Their Value Is Overrated|
|Written by Dr. David Lipschitz Creative Syndicate|
|Thursday, 05 June 2014 04:11|
Every week, one of my patients tells me, "I hear I do not need to have a mammogram -- it causes more harm than good." This impression comes from numerous studies, primarily from Europe, that have questioned the value of mammograms. The most radical proposal, published in The New England Journal of Medicine, recommends mammogram screening for breast cancer be abandoned.
This report, proposed by the Swiss Medical Board, examined the conclusions of a number of research studies demonstrating the value of mammograms. It determined the conclusions might be erroneous. Based on its analysis, mammograms for breast cancer did not prolong life and often resulted in unnecessary surgery that led to a significant incidence of complications. At worst, the needless additional tests, biopsies and even therapy for cancer that would never cause harm may lead to increased mortality and greater suferring. Their report states that at best, mammograms may save one life for every 1,000 mammograms performed over a 10-year period.
Needless to say, this report has led to a storm of controversy in the medical community. Until now, studies have never suggested abandoning mammograms, although the United States Prevenatitive Services Task Force recommends beginning mammograms at age 50 and performing them every 2-3 years, rather than annually. What does a mammogram look for? An abnormality is identified in about 6-8 percent of women. In some cases, this abnormality is clearly benign, and in others, a finding may either diagnose a cancer or suspicious lesion that should be evaluated further or rescreened in 6 months.
In many women who have a suspicious lesion, additional more-detailed imaging studies and biopsies are performed. Finally, and with a great deal of relief, most are told that no cancer was identified. In some, a tiny cancer is identified, leading to surgery, and on occasion, radiotherapy and chemotherapy.
Then why this controversy? Opponents of mammograms have closely evaluated very large studies and are of the belief that many small cancers may resolve spontaneously and that treatment, therefore, is unnecessary.
False positives, unnecessary biopsies and anxiety are all worth it if early detection of a cancer prolongs life. If a woman has an annual mammogram for 10 years, the chance of a false positive leading to further testing is almost 50 percent.
And the earlier detection of cancer does not improve life expectancy or reduce breast cancer death.
No question the defenders of mammography disagree that the test does more harm than good and strongly believe that deaths from breast cancer have been dramatically reduced.
While this contreversy rages, and scientists have widely differeing opinions, it does seem reasonable that woman continue to have mammograms but be more attuned to the potential benefits and harm. Perhaps an annual mammogram might be too frequent. If a mammogram is normal, there is little evidence to suggest delaying the next test for 24 months will identify more cancers than an annual test.
In women who have no significant risk factors for breast cancer, a test every three years might be adequate. But this should be limited to women who have no family history of breast cancer (mothers, sisters, aunts, grandmothers), have never had an abnormal mammogram or breast cancer, and have not taken oral contraceptives for 10 or more years. There are even genetic tests that can be performed to identify women who are at an increased risk of developing breast cancer.
The value of mammograms in women older than 75 is questionable. Most important medical organizations do not have firm recommendations for mammograms within this age group. For example, the American College of Physicians recommends mammograms every two years for women between the ages of 50 and 75 and is against mammograms in women either older or younger than these ages. In contrast, the American Cancer Society recommends a mammogram every one to two years beginning at age 40.
It does seem that in health nothing is absolutely certain. However, until much more information becomes available, please have a mammogram. If you are one of those unlucky few who have developed a cancer, I have no doubt that early detection will dramatically increase remission rates and that the test will have saved your life.
Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz visit www.drdavidhealth.com