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A nurse practitioner’s contrarian view about routine mammograms

Veneta Masson, a nurse practitioner and writer living in Washington, D.C., has written a powerful essay in this month’s issue of the journal Health Affairs on why she no longer gets mammograms. [Hat tip: HealthNewsReview]

As Masson explained to her own (somewhat patronizing) doctor, “I don’t believe early detection guarantees successful treatment or extends life.”

Masson says she came to this conclusion after her sister developed breast cancer and she embarked on a thorough fact-finding mission, which led her to the writings of breast surgeon and women’s health advocate Dr. Susan Love and the reports of several “unfamiliar, foreign-sounding organizations like the Nordic Cochrane Centre.”

The reports from that independent organization (and elsewhere) convinced her that for every woman whose life may be saved by mammography screening, 10 healthy women will undergo unnecessary treatment, including chemotherapy, radiotherapy and having either part or all of a breast removed. And some 200 women will experience a false alarm — a discovery of something unusual in the breast tissue that ends up not being cancer.

“It has not been shown,” she adds, “that women who undergo regular screening live longer than those who don’t.”

But those facts, she acknowledges, have failed to sway many people. “[M]inds that were made up didn’t open to take in this new information,” she says. “The whole engine of breast cancer awareness was — and still is — simply too big, too powerful, and too well funded to gear down.” 

Masson has come up with her own “action plan” regarding breast cancer screening, which she hopes will become, over time, “a new consensus.” Here are some of its components:

“Metastatic breast cancer is terrible, no question. But I agree with the writers of the commentary in the January 13, 2010, issue of the Journal of the American Medical Association that breast cancer is just as treatable and just as deadly regardless of screening. I’ve opted out of routine screening.”

“I might accept the statistical evidence that because I have a first-degree relative who had breast cancer, my own risk is increased, perhaps even doubled. But that fact doesn’t make screening any more valuable to me than it would be to another woman — unless I believe that early detection will guarantee a better outcome for me. I don’t.”

“I’ve made sure that my primary care physician accepts my reasoning and supports me in my choice, although I welcome information from him about new findings that might affect my decision.”

“If there are research breakthroughs that dramatically increase the value of early detection, I’ll rejoice and change my attitude toward screening accordingly.”

“I accept that sooner or later, I’ll die of something. It could be breast cancer. It’s also possible that I’ll die with cancerous changes in my breast (or some other location) that never progressed enough to cause harm.”

“I won’t think less of any woman who continues to get screening mammograms. The weight of public and professional opinion is still on her side.”

“I’m grateful for the gift of good health, recognizing that that’s what it is: a gift,” she concludes. “I will always mourn my sister’s untimely death, which took place three years after her diagnosis despite state-of-the-art treatment. If it were in my power, I’d honor her by redirecting the $5 billion this country spends each year on screening mammography to other purposes. I’d direct those sums instead to the study of how breast cancer starts, and what we can do to treat it more effectively.”

You can read Masson’s essay here [PDF].

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