At age 48 I've never had a mammogram.
OK, everyone still with me?
Before I get attacked for being reckless or foolish (though I'm hoping there are a few Kossacks out there who feel like I do, just because it's always nice to know you're not alone), I thought I'd highlight the latest announcements that simply increase the perennial confusion over the merits of mammograms.
And then I'd be keen to know how this independent-thinking community stands on the perceived benefits of mammography.
Most women are aware that every year or two, MAJOR confusion arises over the merits of mammograms. As the Washington Post reported in "Benefits of Mammograms For Women in 40s Challenged" on Tuesday:
Reopening a long-running debate, the American College of Physicians, which represents 120,000 internists, issued new guidelines today that instead urge women in their 40s to consult with their doctors about whether to have the breast X-rays.
The group based its recommendations on a comprehensive review of mammography research that concluded that the benefits are less clear for women in their 40s than for those 50 and older, and that screening carries significant risks, including exposure to radiation and unnecessary biopsies, surgery and chemotherapy....
"We agree that mammography can save lives," said Douglas K. Owens of Stanford University, who chaired the committee that wrote the guidelines, being published in the Annals of Internal Medicine. "But there are also potential harms. We don't think the evidence supports a blanket recommendation."
What follows are the usual reactions of doctors aghast at even the thought of women thinking twice about mammograms, citing the usual statistics of death rates, demographics and detection effectiveness. These arguments are always countered by other doctors who cite other statistics, like 90 percent of breast cancers are actually found through self-examination.
As the article points out, "breast cancer strikes more than 212,000 U.S. women each year and kills more than 40,000, making it the second most common cancer in women, after skin cancer, and the No. 2 cancer killer, after lung cancer."
While I accept those stats as facts, sad as they are, I'm still not convinced that the benefits of undergoing mammography outweighs the risks. As The Post succinctly put it:
But the [American Cancer Society] recommendations have long been mired in controversy, with some researchers saying that the benefit in that age group is marginal and that the testing subjects thousands to overdiagnosis and overtreatment....
The panel concluded that routine mammography screening might reduce the breast cancer death rate by about 15 percent for women in their 40s, but the data are so unclear that it "could be larger or nearly zero."
Also -- and this point is what always encourages me to continue resisting the mammography marketing:
Mammograms tend to detect a very early form of breast cancer known as ductal carcinoma in situ (DCIS), which may never become life-threatening, the panel noted. Nevertheless, a DCIS diagnosis leads to lumpectomies, mastectomies, radiation and chemotherapy. Mammograms can also miss some cancers, falsely reassuring women, the panel noted.
Even today's New York Times weighed in with an editorial:
The guidelines acknowledge that regular mammograms for women in their 40s can reduce the risk of dying from breast cancer by a modest amount: for every 10,000 women screened, six might avoid death from breast cancer. But a very high percentage of the women screened, the college warns, will get false positive results that lead to unnecessary biopsies, increased costs and risk of injury. There is also a tiny risk that radiation from the screening might itself cause cancer. In the end, women deeply worried about breast cancer will want to get screened, while those who judge — with the help of their doctors — that they are at low risk may prefer to wait.
I fully realize this is a controversial issue fraught with all sorts of emotional and political baggage, including everything from anger over lack of funding for research into female reproductive cancers, to conspiracy theories surrounding cancer as a Big Business.
I also appreciate that mammography is a personal decision made between a woman and her partner, family and/or physician, based on family history and risk factors.
There is no question that mammography saves SOME lives. There will always going to be SOME women -- maybe you or a loved one -- whose fast-growing or genetically induced cancer will be detected or cured because of an expertly read mammogram. But does this mean that ALL women everywhere should be subjected to blanket recommendations, a type of emotional blackmail thanks to fear and ignorance, because PERHAPS mammography has cut breast-cancer rates by 15 percent -- or perhaps not at all?
And, as always, it is difficult to omit the economics from the issue: cancer researchers need to be paid, medical supply companies want to sell their machines, hospitals have to cover their costs.
Me, I've the weighed the risks -- and I'll continue to hold out.