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Resistance to evidence about mammograms may be abating

Slowly women are beginning to realize and accept that annual mammography screening has been oversold to us and that we have other choices.

Women are beginning to realize and accept that annual mammography screening has been oversold.
REUTERS/Enrique Castro-Mendivil

Given how many times women have been told over the decades that “mammography saves lives” and “early detection is the key to surviving breast cancer,” it’s no wonder there’s resistance to studies that challenge both statements.

After all, yearly mammography screening offered women some much-wanted security — a sense that there was something we could do to protect ourselves from a dreaded disease.

To be told after all those years that the screening is more likely to do us harm than good and that many of us have undergone radiation, chemotherapy and disfiguring surgery unnecessarily … well, the anger is understandable.

Attitudes seem to be changing, however. Slowly women are beginning to realize and accept that annual mammography screening has been oversold to us and that we have other choices.

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Attitudes are also changing in the medical community. As I reported here earlier this week, although the American Cancer Society has no current plans to change its recommendation that women have a screening mammogram every year starting at age 40, the organization does acknowledge “that other respected experts do not agree with us.”

That seems like a huge shift in tone to me — a halt to the demonizing of researchers and others who have questioned the effectiveness of annual mammograms.

Some resistance remains

But there is still resistance out there — and anger. Longstanding medical paradigms do not go quietly into the night.

Writing in the New York Times earlier this week, Dr. David Newman, an emergency-room physician in New York City (and author of the book “Hippocrates’ Shadow: Secrets from the House of Medicine”) offers a frank explanation about why physicians have been so reluctant to change their practices in regard to breast-cancer screening:

For years now, doctors like myself have known that screening mammography doesn’t save lives, or else saves so few that the harms far outweigh the benefits. Neither I nor my colleagues have a crystal ball, and we are not smarter than others who have looked at this issue. We simply read the results of the many mammography trials that have been conducted over the years. But the trial results were unpopular and did not fit with a broadly accepted ideology — early detection — which has, ironically, failed (ovarian, prostate cancer) as often as it has succeeded (cervical cancer, perhaps colon cancer).

More bluntly, the trial results threatened a mammogram economy, a marketplace sustained by invasive therapies to vanquish microscopic clumps of questionable threat, and by an endless parade of procedures and pictures to investigate the falsely positive results that more than half of women endure. And inexplicably, since the publication of these trial results challenging the value of screening mammograms, hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy. Why? Because experience deludes: radiologists diagnose, surgeons cut, pathologists examine, oncologists treat, and women survive.

Medical authorities, physician and patient groups, and ‘experts’ everywhere ignore science, and instead repeat history. Wishful conviction over scientific rigor; delusion over truth; form over substance.

Ignoring science

Of course, mammography screening isn’t the only aspect of medicine that calls out for us to stop ignoring science, as Newman points out:

In a system drowning in costs, and at enormous expense, we have systematically ignored virtually identical data challenging the effectiveness of cardiac stents, robot surgeries, prostate cancer screening, back operations, countless prescription medicines, and more. …

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As we begin down the arduous path of health care reform, requisite to economic success, the question for policymakers and health care authorities is this: Are we ready to stop ignoring science? If so, the road may be smoother than we imagined for there is, and has been, much truth to follow.

You can read Newman’s essay on the New York Times website.