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Mammogram debate is both impassioned and nuanced

Finally, perhaps, women are getting the news that breast-cancer screening carries risks as well as benefits and that the decision to undergo screening requires a more nuanced approach than the current one-size-fits-all recommendation that all women, starting at age 40, should have an annual mammogram.

An article in Tuesday’s New York Times goes a long way to explaining why that recommendation oversimplifies the matter  — and to introducing women, who may not have realized it until now, to the fact that cancers experts do not agree on what the evidence actually says (or doesn’t say) about the risks and benefits of mammography screening. Indeed, many experts believe the benefits have been exaggerated.

Reading the article won’t make your decision about screening easier, but it will make that decision more informed.

Writes reporter Denise Grady:

Mammograms are no fun, to put it mildly. Like many women, I have been putting up with them in hopes that, if I get cancer, they might find it early enough to save my life and maybe help me avoid extensive surgery and chemotherapy. Have I been kidding myself?
Hoping to make sense of it all, I consulted several experts. All said mammograms were still important — after all, breast cancer kills 40,000 women a year in this country — but they differed about who really needed them and how often.

The general themes from the differing — and often impassioned — views of the experts interviewed by Grady might be summarized as follows (but, please, read the entire Times article to come to your own conclusion):

  • There remains much debate about whether all women aged 40 to 50 (not just those at high risk of developing breast cancer) benefit from regular screening. The evidence supporting annual screening for this age group is, at best, very weak.
  • There’s more of a consensus (but one that is by no means universal) that women between the ages of 50 and 70 may benefit from screening. But are yearly mammograms necessary? As Grady’s article points out, European women in this age group tend to be screened only every other year, and their breast-cancer death rates are the same as in the United States.
  • The evidence that suggests women over 70 benefit from screening is, again, weak, at best.

Grady concludes her article by sharing how her reporting on this issue has informed her personal decision regarding mammograms:

By the time I finished the interviews I decided that, because I’m between 50 and 60, I’ll keep having mammograms. But I’ve requested the report from my last one to find out about my tissue density, and if it’s low [a factor that suggests a lower risk for breast cancer], I might stretch the interval to 18 months or even 2 years. And I’ll hope that in the meantime research does find a way to tell which tumors will kill you, and which will just sit there and mind their own business until you die of something else.

Comments (1)

  1. Submitted by Logan Clark on 11/20/2009 - 05:04 pm.

    Breast Cancer is the #1 concern for women. Mammograms are a preventative measure as well as an emotional one. Risks are present but risks are also found with breast cancer.

    http://www.iahealth.net/the-mammogram-debate-what-should-you-choose

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