Bad Medicine: Doctor Appointments You Should Skip
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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