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Bad Medicine: Doctor Appointments You Should Skip

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The New Thinking on Mammograms

Many women are squeezing their breasts into the mammo machine when they don't need to, some experts believe. In 2009 the USPSTF set off a firestorm when it said that research did not support annual mammograms for women in their forties and that average-risk women in their fifties could get one every other year. The reason for the shift, the organization says, was that mammograms don't save enough lives to warrant the risks. Although the screenings reduce the breast cancer death rate by 15 percent, mammograms can also cause harm, according to the USPSTF. One review found that women in their forties who had annual mammograms for 10 years had a 56 percent risk of having a false-positive result, which led to further testing for something that turned out to be harmless.

False positives can cause considerable emotional distress, a number of studies found. Such results also lead to unnecessary procedures, like biopsies or the surgical removal of a lump -- or both, as in Jackie Lahey's case.

But that's not the worst of it. Because mammograms tend to catch small slow-growing cancers -- some of which might never cause a problem -- women may undergo radiation therapy, chemotherapy and surgery they don't need. Mammograms even pick up precancers. Recently an advisory group to the National Cancer Institute (NCI) recommended that the word carcinoma be removed from conditions like ductal carcinoma in situ (DCIS), a precursor to breast cancer, so that women aren't frightened into getting aggressive treatment, such as surgery, for something that may never become malignant. "DCIS is quite varied; some are more serious, others less so. The majority of DCIS cases progress very slowly, perhaps over a decade," says Laura Esserman, MD, an expert on the NCI panel.

However, those in favor of annual mammographies counter that we don't yet know which cancers will be slow growing rather than aggressive and that, hey, 15 percent of lives saved is a lot of lives. Plus, a new study of women who died from breast cancer found that 65 percent of the deaths occurred among those who never had a mammogram; half the women diagnosed with fatal cancer were under age 50. But the study, Dr. Esserman points out, merely proves that if you have an aggressive cancer, you're more likely to die from it. "There is no proof that if screened, those who died of breast cancer would somehow have survived," she says.

The bottom line The USPSTF recommends mammograms every two years starting at age 50, while the American Cancer Society still advises annual mammograms for women 40 and over. "I advise women to follow the USPSTF guidelines, but if you're at high risk or have dense breasts, you should get a screening every year, starting at 40," Dr. Esserman says.

Originally published in FITNESS magazine, April 2014.


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bahh24 wrote:

That article is reflecting our healthcare screening is protecting us Obama is making screening a healthcare disaster very bad decision you make on individual health care .

8/23/2014 05:13:52 PM Report Abuse wrote:

I am very disappointed in this story. All I can say is as a healthcare professional "covering your butt" is not something to be ashamed of. It's how you ensure the longevity of your career, care for your patients and put food on the table for your family. Someone who maintains such a laissez faire view of preventative medicine obviously holds no high-stakes roles in the medical community. Stick to writing articles.

3/31/2014 08:11:36 AM Report Abuse
paris10gal wrote:

To any woman who stops having mammograms because they are painful...what's really painful is surgery, radiation and chemotherapy! Ladies, please keep having those mammograms because they are true life savers. Tenderness for a day or two is nothing compared to having cancer treatments. Thank God for mammograms!

3/30/2014 10:09:17 PM Report Abuse
mjsel74 wrote:

What if it were your Mother, Sister, Wife, or Girl Friend that died because they couldn┐t have this type of cancer testing? There needs to be more responsible educating to help woman when they have to go through situations like this. Your website could go a long way in helping to reach out and educate woman and men about cancer and provide resources to help them when they have a cancer scare or are going through cancer treatment rather than giving them an excuse to not take care of their health.

3/30/2014 11:20:03 AM Report Abuse
junkbuster87555 wrote:

Good point. Not much written about docs overdoing it with testing. How much time do we all really need to spend in doctors' offices?What are some of these things basedon besides making some extra money for the practice? I have heard some interesting rebuttal from doctors that have really made no difference years later. Then when I actually wanted to fill a prescription for the one thing that would make me feel better, our United Health Care HMO would not allow the prescription to be filled!

3/30/2014 06:15:01 AM Report Abuse

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