This Just In: Breast Cancer Screening Essentially Useless
A certain SOMEONE that I know who is a healthy middle aged woman had to undergo a colonoscopy cuz her gynecologist came up with a positive guaiac test (screening for internal bleeding). Only AFTER the scope did I start to wonder about if there could be false positives, and me ‘n goolgle learned that if you eat a lot of tomatoes you can come up false positive, and since she is Yugoslavian (har, har) she eats a lot of tomatoes. Her physician SHOULD HAVE warned her of that. Doh! Now her mammogram got flagged for additional testing and I am starting to wonder (yup) could it be false positive?
That is why an article in this weeks’s bmj about breast cancer screening caught my eye. Current recommendations state that women over 50 should get yearly mammograms, and pamphlets say that screening will save lives and decrease mastectomies, which, alas, is apparently not true. The article shows that one in 10,000 women will be saved from a death related to breast cancer if they get yearly mammograms. However, 5% of mammograms come up as false positives, meaning that women will have to wait for months with anxiety, coming back in for more painful and expensive tests, all for nothing. And what is more, over a ten year period there is a 50% chance of a false positive. That means that women getting mammograms as recommended can flip a coin; heads you get a false positive reading, tails you don’t.
And what is worse, if you are found to have a cancer in situ, which constitutes 20% of cases, that will likely lead to radiation, even though less than half of these cases will progress to a spreading cancer. Obtaining this information was described as lilke “trying to uncover a closely guarded state secret.”
Which brings us to the fact that breast cancer screening has not been shown to have any effect on mortality. The implication is that for each life saved from breast cancer, there is one life lost due to the effects of radiation treatment for something like cancer in situ that would never have progressed anyway.
In other words, breast cancer screening is of little substantive value.
Arghhh!
Let’s start making our list of useless screening procedures.
Hat tip to the Gary Schwitzer Health News Blog.
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By Gina Pera, February 9, 2009 @ 11:53 am
Amen, Doug.
It goes against “by the numbers” medicine, but I’ve been getting a mammogram only every other year (and when I was younger, every third or fourth year). Too many friends with false positives, as you say, and no doubt some unnecessary procedures. Not to mention the radiation exposure.
In between: palpation by my MD and self-exams.
By Steph, February 9, 2009 @ 12:41 pm
I refuse to get mammograms. We know that radiation causes cancer. We know that until insurance companies started insisting on yearly mammograms for women over 40, breast cancer was considerably more rare than it is today. Now, with most women over 40 having their breasts shot full of radiation once a year via the mandated mammogram, we have a helluva lot more breast cancer. Gosh, wonder why? Could it be that we’re exposing our breasts to cancer-causing radiation?
By Doug Bremner, February 9, 2009 @ 12:44 pm
The implication is that a decrease in breast cancer related deaths with no overall decrease in mortality means that women getting mammograms are dying of something else… like other cancers caused by the radiation from getting treated for breast cancer in situ which has a less than 50% chance of proceeding to “real” breast cancer.
By Gina Pera, February 9, 2009 @ 1:10 pm
Oh, and no surprise about the doc not knowing the tomato connection.
I suspect many false positives with mammograms come from calcium deposits — caused by this unsubstantiated frenzy to pump women full of calcium. Given that most Americans are already magnesium-deficient, it’s a particularly bad idea to supplement calcium without first addressing the mag deficiency.
But will most MDs know about the calcium connection. Not on your life.
By Stephany, February 9, 2009 @ 1:16 pm
All that flattening for no good reason; hmmm.
By Ken Rubenstein, February 9, 2009 @ 1:46 pm
Hey, the suffering economy needs more of everything. Results be damned.
By Nancy Fruge, February 9, 2009 @ 2:32 pm
I am over 50 years old and, like Gina, I have been getting a mammogram every other year (even though my health care provider recommends it yearly). I have been putting off the recommended colonoscopy for several years.
Thank you for posting this, Doug…reminds us of the importance of prevention. The National Cancer Institute lists ways to help prevent breast cancer on its Web site, here:
http://www.cancer.gov/cancertopics/pdq/prevention/breast/Patient/page3#Keypoint3
By Therapy Patient, February 9, 2009 @ 3:25 pm
One particular mammogram center I went to came up with a false positive, or perhaps the X-Ray was just uninterpretable, so they sent me for a sonogram at additional cost (in the same facility). It left me wondering 2 things: (a) did I really NEED the sonogram or were they trying to get full usage of their sonogram equipment? (b) if the sonogram works BETTER and there is no radiation from the sonogram (plus no painful breast flattening) why do women not get a yearly breast sonogram instead?
Could an increase in breast cancer rates be the result of a longer life expectancy rather than the result of mammograms? I wonder about breast cancer rates in particular age groups for similar stage cancers. I’d rather be diagnosed with early stage breast cancer at a younger age than more advanced cancer at a later age.
Considering the male bias in medicine, if there were something to be gained by scanning testicles, do you suppose that men would be required to have their testicle squished flat between cold metal platens annually and X-Rayed or do you think men would have a sonogram as the “standard” test. Why AREN’T sonograms offered instead for women?
Also, I am curious about digital mammograms. My gyn doctor insists that digital mammograms are superior to film mammograms because they are “state of the art”. As a professional photographer, I don’t understand why that would be. I assume the X-Ray radiation would be the same. Digital versus film is the capture medium. Digital is cheaper than film, but not better in photography except in its ability to be retouched. Why would digital capture improve the diagnosis?
By Doug Bremner, February 9, 2009 @ 3:35 pm
I don’t know about relative risk/utility of sonograms etc. I remember from my radiology days that mammograms are the MOST unreliable and radiologist spend many hours obsessiving over then and they are fraught with false positives. Pamphlets highlighting benefits and ignoring risks of uncomfort and false positives and falsely promoting reduction in mortality are not providing true informed consent.
By Gianna, February 9, 2009 @ 4:17 pm
I’ve been told to get mammograms since turning 40 not 50. After one scare–my very first mammogram (false positive) I did some research and I haven’t returned for another and won’t.
By Cousin in Eastern Washington, February 9, 2009 @ 4:29 pm
Hi Doug, you are talking about one of my favorite toys! I would like to know more about the sonogram deal. If it is as equal to the x-ray, why aren’t they using this more? Anna just had one last week, and I am quite positive she would like to be more informed on this also. Her Gyn. sends her in every year, and if there is a less evasive test with equal results she should be able to make that decision right? My cousin had a double mastectomy 10 years ago, 6 months after her Mom died of cancer. She thinks she did the right thing as her Aunt died from it. She is now a nurse because of her life changing event. She has also dealt with tumors on her spine, shes a tough gal! I am quite sure she will want to know more about this. It makes sense!
By Therapy Patient, February 9, 2009 @ 9:08 pm
Cousin, on researching ultrasound (sonogram) of the breast, I found that ultrasound is not approved by the U.S. Food and Drug Administration as a screening tool for cancer because “it lacks the detail (spacial resolution) of conventional mammography. It cannot detect most calcium deposits on breast tumors (calcifications).” Ultrasound is used more frequently to distinguish liquid filled cysts from solid masses. More expensive is the MRI which is approved by the FDA and is not affected by scarring of surgeries, breast implants or dense breasts which interfere with x-ray mammograms. My gyn wants me to get a mammogram in May. Regardless of opinions expressed on blogs or in articles, in the end it always comes down to each individual patient having to defy her doctor’s orders when it comes to mammography or any of a zillion other things which are prescribed or “ordered”.
By Doug Bremner, February 9, 2009 @ 10:00 pm
you can have a conversation about it, though.
By Gianna, February 9, 2009 @ 11:45 pm
defy a doctor’s “orders?”
if my doctor ordered anything I’d run…that is how I got so hurt…
I learned the hard way in the end that I know more than most docs about my condition…and I paid dearly getting to this place…because for many years I trusted them.
now I never assume they know best. period.
By Marilyn Mann, February 10, 2009 @ 11:22 am
This is not an issue for me since I was already diagnosed with early stage breast cancer in 2007, unfortunately. It will someday be an issue for my daughter, however, and I am interested in the topic anyway. Can you cite the evidence you are relying on for your statement that breast cancer screening does not reduce mortality? Thanks.
By Doug Bremner, February 10, 2009 @ 11:28 am
From the bmj paper:
Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2006;(4):CD001877.
By Dave Affinito, February 17, 2009 @ 7:35 am
Doug, my wife had a mamogram which was negative. Thank God the doc had the foresight to order an MRI, which picked up the tumor in time. If he hadn’t ordered the MRI, who knows where she’d be now. BTW Horizon B/C won’t pay for her MRI’s anymore. They said the mamogram is all that’s necessary.
By Doug Bremner, February 17, 2009 @ 8:41 am
Why did he order an MRI? Was there a lump?
By By Cynthia Affinito, February 17, 2009 @ 1:23 pm
I could have traced the outline of the tumor with a pen, yet the mammogram was negative. The ultrasound was “suspicious”,
the MRI and PET scan conclusive. I refused a needle biopsy.
By Doug Bremner, February 17, 2009 @ 2:03 pm
Goodness. Yes mammographies are fairly useless and noone wants to read them. Half of tumors are found in between scheduled mammograms.